Provider Demographics
NPI:1457724114
Name:CENTER FOR FUNCTIONAL REHABILITATION
Entity Type:Organization
Organization Name:CENTER FOR FUNCTIONAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAJJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MURTAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-757-4647
Mailing Address - Street 1:820 W JACKSON BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3026
Mailing Address - Country:US
Mailing Address - Phone:312-757-4647
Mailing Address - Fax:312-724-7647
Practice Address - Street 1:820 W JACKSON BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3026
Practice Address - Country:US
Practice Address - Phone:312-757-4647
Practice Address - Fax:312-724-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117058261QM1300X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty