Provider Demographics
NPI:1518127539
Name:INFINITY REHAB
Entity Type:Organization
Organization Name:INFINITY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:815-499-1269
Mailing Address - Street 1:208 E 9TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-2444
Mailing Address - Country:US
Mailing Address - Phone:815-499-1269
Mailing Address - Fax:
Practice Address - Street 1:208 E 9TH ST APT A
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-2444
Practice Address - Country:US
Practice Address - Phone:815-499-1269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1484895314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility