Provider Demographics
NPI:1578832069
Name:217 REHAB & PERFORMANCE CENTER
Entity Type:Organization
Organization Name:217 REHAB & PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER/HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-356-6150
Mailing Address - Street 1:924 W CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1067
Mailing Address - Country:US
Mailing Address - Phone:815-844-4041
Mailing Address - Fax:815-844-4810
Practice Address - Street 1:1806 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1312
Practice Address - Country:US
Practice Address - Phone:217-356-7167
Practice Address - Fax:217-356-7167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEWORKS ILLINOIS OCCUPATIONAL HEALTHSERVICES, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy