Provider Demographics
NPI:1720104110
Name:REHAB MANAGEMENT SPECIALISTS, PC
Entity type:Organization
Organization Name:REHAB MANAGEMENT SPECIALISTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-804-9332
Mailing Address - Street 1:12172 S STATE ROUTE 47 STE 319
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9619
Mailing Address - Country:US
Mailing Address - Phone:312-804-9332
Mailing Address - Fax:815-943-0196
Practice Address - Street 1:109 W FRONT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2833
Practice Address - Country:US
Practice Address - Phone:312-804-9332
Practice Address - Fax:815-943-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634788OtherBLUE CROSS BLUE SHEILD
IL1634788OtherBLUE CROSS BLUE SHEILD