Provider Demographics
NPI:1851445316
Name:OMNIS REHAB,INC
Entity Type:Organization
Organization Name:OMNIS REHAB,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DARIUSZ
Authorized Official - Middle Name:BOGUSLAW
Authorized Official - Last Name:STOPKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:874-471-9159
Mailing Address - Street 1:110 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2426
Mailing Address - Country:US
Mailing Address - Phone:847-471-9159
Mailing Address - Fax:708-452-1072
Practice Address - Street 1:110 SENECA TRL
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2426
Practice Address - Country:US
Practice Address - Phone:847-471-9159
Practice Address - Fax:708-452-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy