Provider Demographics
NPI:1568476893
Name:CRESCENT REHAB CENTER, PC
Entity Type:Organization
Organization Name:CRESCENT REHAB CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IMITIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-277-9955
Mailing Address - Street 1:10 EXECUTIVE CT
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9506
Mailing Address - Country:US
Mailing Address - Phone:847-277-9955
Mailing Address - Fax:847-277-9958
Practice Address - Street 1:10 EXECUTIVE CT
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9506
Practice Address - Country:US
Practice Address - Phone:847-277-9955
Practice Address - Fax:847-277-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633036OtherBCBS PT AND OT GROUP
IL207718Medicare ID - Type UnspecifiedOT GROUP
IL211439Medicare ID - Type UnspecifiedOT GROUP
IL213265Medicare ID - Type UnspecifiedOT GROUP
IL207644Medicare ID - Type UnspecifiedPT GROUP
IL01633036OtherBCBS PT AND OT GROUP
IL213264Medicare ID - Type UnspecifiedPT GROUP
IL211441Medicare ID - Type UnspecifiedPT GROUP