Prorehab PC

NPI #1104467547 in Perryville, Missouri

Provider Information

NPI Number: 1104467547
Entity Type: Organization
Organization Name: Prorehab PC
Primary Specialty: Clinic/Center
Enumeration Date: Oct 7, 2019
Last Updated: Oct 7, 2019

Practice Location

Address: 1418 W SAINT JOSEPH ST STE 170
City: Perryville
State: Missouri
ZIP Code: 63775-1678
Phone: (573) 513-8170

Authorized Official

Name: JUANA GRANADOS
Title: CREDENTIALING MANAGER
Phone: (630) 575-1980

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X
Occupational Therapist	225X00000X
Clinic/Center	261Q00000X	Primary

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