Provider Demographics
NPI:1558143727
Name:GROUND UP REHAB LLC
Entity Type:Organization
Organization Name:GROUND UP REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-234-5715
Mailing Address - Street 1:313 W WOLF POINT PLZ UNIT 2002
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 W WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-0518
Practice Address - Country:US
Practice Address - Phone:773-802-3229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty