Provider Demographics
NPI:1386321404
Name:PROTOCOL 1 REHAB, LLC
Entity type:Organization
Organization Name:PROTOCOL 1 REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-362-6055
Mailing Address - Street 1:524 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2901
Mailing Address - Country:US
Mailing Address - Phone:630-362-6055
Mailing Address - Fax:
Practice Address - Street 1:524 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2901
Practice Address - Country:US
Practice Address - Phone:630-362-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty