Provider Demographics
NPI:1629118005
Name:BELLEVILLE REHABILITATION SERVICES,LTD
Entity Type:Organization
Organization Name:BELLEVILLE REHABILITATION SERVICES,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NORTON
Authorized Official - Last Name:KLOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:618-236-1081
Mailing Address - Street 1:333 S ILLINOIS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2153
Mailing Address - Country:US
Mailing Address - Phone:618-236-1081
Mailing Address - Fax:618-236-1265
Practice Address - Street 1:333 S ILLINOIS ST
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2153
Practice Address - Country:US
Practice Address - Phone:618-236-1081
Practice Address - Fax:618-236-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL609640Medicare ID - Type Unspecified