Provider Demographics
NPI:1407858483
Name:VITAL REHABILITATION ASSOCIATION, INC.
Entity Type:Organization
Organization Name:VITAL REHABILITATION ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/HEAD THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOKOCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PHYSICAL TH
Authorized Official - Phone:773-685-8482
Mailing Address - Street 1:5820 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2616
Mailing Address - Country:US
Mailing Address - Phone:773-685-8482
Mailing Address - Fax:773-685-8479
Practice Address - Street 1:5820 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2616
Practice Address - Country:US
Practice Address - Phone:773-685-8482
Practice Address - Fax:773-685-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204275Medicare ID - Type Unspecified