1013069954 NPI number — METT REHABILITATION

Table of content: LISA MARGARET CAVENEY P.T. (NPI 1942501440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013069954 NPI number — METT REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METT REHABILITATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013069954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 DIXIE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60411-1748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-709-6535
Provider Business Mailing Address Fax Number:
708-709-6252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60411-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-709-6535
Provider Business Practice Location Address Fax Number:
708-709-6252
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
708-709-6535

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1621151 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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