Basic Information
| Provider Information | |||||||||
| NPI: | 1760544951 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEWSOME REHABILITATION CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEWSOME PHYSICAL THERAPY NETWORK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 ESSINGTON RD | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604352859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157444770 | ||||||||
| FaxNumber: | 8157441845 | ||||||||
| Practice Location | |||||||||
| Address1: | 25445 S PHEASANT LN | ||||||||
| Address2: | UNIT H | ||||||||
| City: | CHANNAHON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604108838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155210111 | ||||||||
| FaxNumber: | 8155210222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HATZL | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING COLLECTIONS SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8157444770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.