Provider Demographics
NPI:1356430425
Name:PROFESSIONAL REHABILITATION GROUP
Entity type:Organization
Organization Name:PROFESSIONAL REHABILITATION GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-877-8050
Mailing Address - Street 1:44 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3413
Practice Address - Country:US
Practice Address - Phone:847-877-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
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