Provider Demographics
NPI:1548032980
Name:REPRIME REHAB AND PERFORMANCE PLLC
Entity type:Organization
Organization Name:REPRIME REHAB AND PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOILESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:847-421-4269
Mailing Address - Street 1:3122 REHBEHN CT
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2435
Mailing Address - Country:US
Mailing Address - Phone:847-421-4269
Mailing Address - Fax:
Practice Address - Street 1:3122 REHBEHN CT
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2435
Practice Address - Country:US
Practice Address - Phone:847-421-4269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty