Provider Demographics
NPI:1811418015
Name:PR ORTHOTICS & OT, LLC
Entity type:Organization
Organization Name:PR ORTHOTICS & OT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ROGEL
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:224-470-8550
Mailing Address - Street 1:4711 GOLF ROAD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:224-470-8550
Mailing Address - Fax:224-470-8553
Practice Address - Street 1:4711 GOLF ROAD
Practice Address - Street 2:SUITE 525
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:224-470-8550
Practice Address - Fax:224-470-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1841338860Medicaid