Provider Demographics
NPI:1639514854
Name:SPINE REHABILITATION AND PAIN CLINIC
Entity Type:Organization
Organization Name:SPINE REHABILITATION AND PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RZESZUTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:630-307-0200
Mailing Address - Street 1:2190 GLADSTONE CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDALE HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1519
Mailing Address - Country:US
Mailing Address - Phone:630-307-0200
Mailing Address - Fax:312-377-1664
Practice Address - Street 1:2190 GLADSTONE CT
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE HTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1519
Practice Address - Country:US
Practice Address - Phone:630-307-0200
Practice Address - Fax:312-377-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty