NPIMap

Organization Active NPI

Waukegan Medical & Rehabilitation

  • Physical Therapy Assistant
  • Waukegan, IL
National Provider Identifier
1114348349
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
160004131 Issued in IL
Legal business name
WAUKEGAN MEDICAL & REHABILITATION
Practice address
1720 Grand Ave
Waukegan, IL 60085-3502
Phone
(847) 625-0202
Fax
(847) 625-0101
NPI assigned
Dec 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ivan Bracic, D.C.
Title
President/Owner
Phone
(847) 625-0202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X 160004131 IL Primary

Addresses

Primary practice location

1720 Grand Ave
Waukegan, IL 60085-3502

Mailing address

1720 Grand Ave.
Waukekgan, IL 60085
Phone (847) 625-0202

National Provider Directory

National Provider Directory
Tax ID family
Waukegan Medical and Rehabilitation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1114348349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 GRAND AVE.",
            "city": "WAUKEKGAN",
            "state": "IL",
            "postal_code": "60085",
            "telephone_number": "847-625-0202",
            "fax_number": "847-625-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853502",
            "telephone_number": "847-625-0202",
            "fax_number": "847-625-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUKEGAN MEDICAL & REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-13",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "BRACIC",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "847-625-0202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160004131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.