Provider Demographics
NPI:1700838331
Name:FLEXEON REHABILITATION OF MUNSTER, LLC
Entity Type:Organization
Organization Name:FLEXEON REHABILITATION OF MUNSTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-427-4192
Mailing Address - Street 1:1420 KENSINGTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2143
Mailing Address - Country:US
Mailing Address - Phone:630-427-4192
Mailing Address - Fax:630-574-1681
Practice Address - Street 1:8317 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1737
Practice Address - Country:US
Practice Address - Phone:219-924-3512
Practice Address - Fax:219-924-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006795A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN199620Medicare PIN