Provider Demographics
NPI:1013154335
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/COLLECTION SUPERVISOR
Authorized Official - Prefix:
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-744-4770
Mailing Address - Fax:815-744-1845
Practice Address - Street 1:920 ESSINGTON ROAD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-744-4770
Practice Address - Fax:815-744-1845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWSOME REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146636Medicare Oscar/Certification