Provider Demographics
NPI:1760544951
Name:NEWSOME REHABILITATION CENTER
Entity Type:Organization
Organization Name:NEWSOME REHABILITATION CENTER
Other - Org Name:NEWSOME PHYSICAL THERAPY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COLLECTIONS SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HATZL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-744-4770
Mailing Address - Street 1:920 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2859
Mailing Address - Country:US
Mailing Address - Phone:815-744-4770
Mailing Address - Fax:815-744-1845
Practice Address - Street 1:25445 S PHEASANT LN
Practice Address - Street 2:UNIT H
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8838
Practice Address - Country:US
Practice Address - Phone:815-521-0111
Practice Address - Fax:815-521-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146636Medicare Oscar/Certification