Provider Demographics
NPI:1194898114
Name:VITAL REHABILITATION & PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:VITAL REHABILITATION & PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMASZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOKOCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-371-6441
Mailing Address - Street 1:5820 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-685-8482
Mailing Address - Fax:773-685-8479
Practice Address - Street 1:11600 S KEDZIE
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803
Practice Address - Country:US
Practice Address - Phone:708-371-6441
Practice Address - Fax:708-371-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
211899Medicare ID - Type Unspecified