Provider Demographics
NPI:1124533039
Name:REZIN ORTHOPEDIC AND SPORTS MEDICINE, SC
Entity type:Organization
Organization Name:REZIN ORTHOPEDIC AND SPORTS MEDICINE, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPIELEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-942-4875
Mailing Address - Street 1:1051 W US ROUTE 6 STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3370
Mailing Address - Country:US
Mailing Address - Phone:815-942-4875
Mailing Address - Fax:815-942-5046
Practice Address - Street 1:1312 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9215
Practice Address - Country:US
Practice Address - Phone:815-553-2860
Practice Address - Fax:815-725-8520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REZIN ORTHOPEDICS AND SPORTS MEDICINE, S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007183207X00000X, 225100000X, 225X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty