Basic Information
| Provider Information | |||||||||
| NPI: | 1821284829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWSOME REHABILITATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 N KENNEDY DR | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609012900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159327787 | ||||||||
| FaxNumber: | 8159327895 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 N KENNEDY DR | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609012900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159327787 | ||||||||
| FaxNumber: | 8159327895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | HATZL | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AND COLLECTIONS SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8157444770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEWSOME PHYSICAL THERAPY NETWORK | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070007936 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.