Provider Demographics
NPI:1720010168
Name:PRO-REHAB SERVICES, P.C.
Entity Type:Organization
Organization Name:PRO-REHAB SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHOLAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-489-6777
Mailing Address - Street 1:6400 W COLLEGE DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1785
Mailing Address - Country:US
Mailing Address - Phone:708-489-6777
Mailing Address - Fax:708-489-6303
Practice Address - Street 1:6400 W COLLEGE DR
Practice Address - Street 2:SUITE 800
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1785
Practice Address - Country:US
Practice Address - Phone:708-489-6777
Practice Address - Fax:708-489-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146656Medicare ID - Type UnspecifiedOUTPATIENT REHAB FACILITY