Provider Demographics
NPI:1881963288
Name:ELITE REHABILITATION INSTITUTE, PHYSICAL THERAPY, LTD
Entity type:Organization
Organization Name:ELITE REHABILITATION INSTITUTE, PHYSICAL THERAPY, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PUC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-615-9170
Mailing Address - Street 1:28 N CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1602
Mailing Address - Country:US
Mailing Address - Phone:630-615-9170
Mailing Address - Fax:630-493-0995
Practice Address - Street 1:13520 SOUTH RTE. 59
Practice Address - Street 2:SUITE 106
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-254-1159
Practice Address - Fax:815-254-1159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANK PUC, INC. DBA PERSONAL BEST PERFORMANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-14
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013955261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy