Provider Demographics
NPI:1609100254
Name:FLEXEON REHABILITATION OF LOCKPORT, LLC
Entity Type:Organization
Organization Name:FLEXEON REHABILITATION OF LOCKPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-610-8951
Mailing Address - Street 1:17130 PRIME BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-1311
Mailing Address - Country:US
Mailing Address - Phone:815-512-7070
Mailing Address - Fax:815-512-7030
Practice Address - Street 1:17130 PRIME BLVD
Practice Address - Street 2:STE B
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-1311
Practice Address - Country:US
Practice Address - Phone:815-512-7070
Practice Address - Fax:815-512-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty