Provider Demographics
NPI:1508088030
Name:N SHORE SPINAL & SPORTS REHAB LTD
Entity Type:Organization
Organization Name:N SHORE SPINAL & SPORTS REHAB LTD
Other - Org Name:NORTH SHORE CERTIFIED OUTPATIENT REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-899-1284
Mailing Address - Street 1:1770 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3210
Mailing Address - Country:US
Mailing Address - Phone:847-432-4077
Mailing Address - Fax:847-818-9406
Practice Address - Street 1:1770 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3210
Practice Address - Country:US
Practice Address - Phone:847-432-4077
Practice Address - Fax:847-681-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146596Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER