Provider Demographics
NPI:1952524563
Name:NORTH AMERICA REHAB SERVICES, INC.
Entity Type:Organization
Organization Name:NORTH AMERICA REHAB SERVICES, INC.
Other - Org Name:ESSENCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:773-763-1212
Mailing Address - Street 1:6730 W HIGGINS AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2106
Mailing Address - Country:US
Mailing Address - Phone:773-205-8911
Mailing Address - Fax:773-205-6481
Practice Address - Street 1:6413 N KINZUA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:773-763-1212
Practice Address - Fax:773-763-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
070006443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23421Medicare UPIN
IL212745Medicare ID - Type UnspecifiedMEDICARE GROUP