Provider Demographics
NPI:1487704409
Name:P D REHAB, INC.
Entity type:Organization
Organization Name:P D REHAB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NORBERT
Authorized Official - Last Name:DOMAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-459-4779
Mailing Address - Street 1:920 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3444
Mailing Address - Country:US
Mailing Address - Phone:847-459-4779
Mailing Address - Fax:847-459-5771
Practice Address - Street 1:920 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3444
Practice Address - Country:US
Practice Address - Phone:847-459-4779
Practice Address - Fax:847-459-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
208912Medicare ID - Type Unspecified
K06200Medicare UPIN