Basic Information
| Provider Information | |||||||||
| NPI: | 1346538196 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECKMAN REHAB CENTER OSWEGO INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 W VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | OSWEGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605437211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305536888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26 W VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | OSWEGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605437211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305536888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2011 | ||||||||
| LastUpdateDate: | 07/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | SPECKMAN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6305536888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070007763 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.