Provider Demographics
NPI:1982726683
Name:GRAYSLAKE REHABILITATION AND COMPLETE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:GRAYSLAKE REHABILITATION AND COMPLETE PHYSICAL THERAPY LLC
Other - Org Name:GRAYSLAKE REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-223-8001
Mailing Address - Street 1:997 N CORPORATE CIR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7822
Mailing Address - Country:US
Mailing Address - Phone:847-223-8001
Mailing Address - Fax:847-986-3580
Practice Address - Street 1:997 N CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7822
Practice Address - Country:US
Practice Address - Phone:847-223-8001
Practice Address - Fax:847-986-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211232Medicare ID - Type UnspecifiedLEGACY NUMBER