Provider Demographics
NPI:1518059336
Name:REHABILITY SC
Entity Type:Organization
Organization Name:REHABILITY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-415-0344
Mailing Address - Street 1:600 W CHICAGO AVE
Mailing Address - Street 2:RIVERWALK #4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:312-644-4500
Mailing Address - Fax:312-644-4501
Practice Address - Street 1:600 W CHICAGO AVE
Practice Address - Street 2:RIVERWALK #4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-644-4500
Practice Address - Fax:312-644-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70013088225100000X
IL111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210417Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER