Provider Demographics
NPI:1922190610
Name:RIMBO, DONALD S (PT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:RIMBO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 STATE ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4489
Practice Address - Country:US
Practice Address - Phone:630-296-3103
Practice Address - Fax:630-243-1203
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00875216OtherMEDICARE RAILROAD
ILP00354011Medicare PIN
IL202845103Medicare PIN
ILP00875216OtherMEDICARE RAILROAD
ILK00970Medicare PIN
ILR01042Medicare PIN
ILL98615Medicare PIN