Provider Demographics
NPI:1104886373
Name:WOMENS HEALTH REHABILITATION CENTERS PC
Entity type:Organization
Organization Name:WOMENS HEALTH REHABILITATION CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:YOUNGBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-557-3828
Mailing Address - Street 1:18425 W WEST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6768
Mailing Address - Country:US
Mailing Address - Phone:708-557-3828
Mailing Address - Fax:877-322-6752
Practice Address - Street 1:18425 WEST CREEK DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6768
Practice Address - Country:US
Practice Address - Phone:708-557-3828
Practice Address - Fax:877-322-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
070005818261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932431OtherBLUE CROSS
IL212460Medicare PIN