| Organization Name: | TRICARE REHAB |
| NPI Number: | 1144597139 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JILL BROGDON (VICE PRESIDENT OF OPERATIONS) |
| Mailing Address: | 150 Fencl Ln Hillside |
| State: | IL US |
| Postal Code: | 601622041 |
| Phone Number: | 8124323610 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2011 |
| NPI Last Update Date: | 11/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 99048396A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |