Provider Demographics
NPI:1740377019
Name:UNIVERSAL REHABILITATION SERVICES P.C.
Entity type:Organization
Organization Name:UNIVERSAL REHABILITATION SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HATEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-296-9771
Mailing Address - Street 1:9614 S MERTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-296-9771
Mailing Address - Fax:
Practice Address - Street 1:9614 MERTON AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2705
Practice Address - Country:US
Practice Address - Phone:708-296-9771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213211Medicare ID - Type Unspecified