Provider Demographics
NPI:1871661827
Name:FLEXEON REHABILITATION - CLINTON, LLC
Entity Type:Organization
Organization Name:FLEXEON REHABILITATION - CLINTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-922-9508
Mailing Address - Street 1:211 N CLINTON ST
Mailing Address - Street 2:SUITE 2 SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1282
Mailing Address - Country:US
Mailing Address - Phone:312-268-6050
Mailing Address - Fax:312-258-0335
Practice Address - Street 1:211 N CLINTON ST
Practice Address - Street 2:SUITE 2 SOUTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1282
Practice Address - Country:US
Practice Address - Phone:312-268-6050
Practice Address - Fax:312-258-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214543Medicare PIN