Provider Demographics
NPI:1770565491
Name:PRACTICAL REHAB SERVICES, LTD.
Entity type:Organization
Organization Name:PRACTICAL REHAB SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-465-6566
Mailing Address - Street 1:3550 COLLEGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5008
Mailing Address - Country:US
Mailing Address - Phone:618-465-6566
Mailing Address - Fax:618-465-6573
Practice Address - Street 1:3550 COLLEGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5008
Practice Address - Country:US
Practice Address - Phone:618-465-6566
Practice Address - Fax:618-465-6573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL327366709001Medicaid
IL348589310001Medicaid
IL146651Medicare ID - Type Unspecified