Basic Information
| Provider Information | |||||||||
| NPI: | 1881963288 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELITE REHABILITATION INSTITUTE, PHYSICAL THERAPY, LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PERSONAL BEST PERFORMANCE OF PLAINFIELD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 N CASS AVE | ||||||||
| Address2: | |||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605591602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306159170 | ||||||||
| FaxNumber: | 6304930995 | ||||||||
| Practice Location | |||||||||
| Address1: | 13520 SOUTH RTE. 59 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | PLAINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152541159 | ||||||||
| FaxNumber: | 8152541159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PUC | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | MARTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6306159170 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FRANK PUC, INC. DBA PERSONAL BEST PERFORMANCE | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 070013955 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.