Provider Demographics
NPI:1609940162
Name:THER-A-CARE REHABILITATION LTD
Entity Type:Organization
Organization Name:THER-A-CARE REHABILITATION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-634-3550
Mailing Address - Street 1:35 E WILLOW ST STE A
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1868
Mailing Address - Country:US
Mailing Address - Phone:815-634-3550
Mailing Address - Fax:
Practice Address - Street 1:35 E WILLOW ST STE A
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1868
Practice Address - Country:US
Practice Address - Phone:815-634-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL473901815001Medicaid
IL3232028OtherBLUE CROSS BLUE SHIELD
ILDF7483OtherRAILROAD MEDICARE GROUP NUMBER
ILP00390229OtherRAILROAD MEDICARE PTAN
IL473901815001Medicaid
ILP00390229OtherRAILROAD MEDICARE PTAN