Provider Demographics
NPI:1437297884
Name:COBBLESTONE REHABILITATION, L.P.
Entity Type:Organization
Organization Name:COBBLESTONE REHABILITATION, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-366-0033
Mailing Address - Street 1:PO BOX 6694
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61826-6694
Mailing Address - Country:US
Mailing Address - Phone:217-366-0033
Mailing Address - Fax:217-366-0012
Practice Address - Street 1:4102 BELMONT PT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3506
Practice Address - Country:US
Practice Address - Phone:217-366-0033
Practice Address - Fax:217-366-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01032020OtherBLUE CROSS BLUE SHIELD IL
IL146663Medicare ID - Type Unspecified