NPIMap

Organization Active NPI

Tricare Rehab

  • Physical Therapy Clinic/Center
  • Hillside, IL
National Provider Identifier
1144597139
Registry record updated Nov 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
99048396A Issued in IN
Legal business name
TRICARE REHAB
Practice address
150 Fencl LN
Hillside, IL 60162-2041
Phone
(812) 432-3610
NPI assigned
Nov 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2011

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

Authorized official

Name
Jill Brogdon
Title
Vice President of Operations
Phone
(219) 898-3422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 99048396A IN Primary

Addresses

Primary practice location

150 Fencl LN
Hillside, IL 60162-2041

Mailing address

12803 Lenover St.
Dillsboro, IN 47018
Phone (812) 432-3610

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1321660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321660800000",
    "number": "1144597139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12803 LENOVER ST.",
            "city": "DILLSBORO",
            "state": "IN",
            "postal_code": "47018",
            "telephone_number": "812-432-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 FENCL LN",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601622041",
            "telephone_number": "812-432-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRICARE REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-19",
        "last_updated": "2011-11-19",
        "status": "A",
        "authorized_official_last_name": "BROGDON",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "219-898-3422"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IN",
            "license": "99048396A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillside, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2011; 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.