Active NPI
Creative Rehab, Inc.
- Physical Therapy Clinic/Center
- Gurnee, IL
National Provider Identifier
1487723359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- Legal business name
- CREATIVE REHAB, INC.
- Practice address
- 222 S Greenleaf St
Suite 101
Gurnee, IL 60031-5705 - Phone
- (847) 599-9171
- Fax
- (847) 599-9124
- NPI assigned
- Nov 7, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Anita Davidson, PT
- Title
- Ownner
- Phone
- (847) 599-9171
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | Primary |
Addresses
Primary practice location
222 S Greenleaf St
Suite 101
Gurnee, IL 60031-5705
Mailing address
4835 Kingsway West
Gurnee, IL 60031-5705
Phone (847) 599-9171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180705001994 | IL | Part B Supplier - Clinic/Group Practice | 3173879186 |
Receives reassigned benefits from 10 practitioners Practice locations: Gurnee, IL |
National Provider Directory
National Provider DirectoryLocations
222 S Greenleaf St
Ste 101
Gurnee, IL 60031
Phone (847) 599-9171
Practitioners & affiliated clinicians
Practitioners 13
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Gurnee, IL
- NPI 1598071078
-
- Physical Therapist
- Gurnee, IL
- NPI 1790091270
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1487723359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4835 KINGSWAY WEST",
"city": "GURNEE",
"state": "IL",
"postal_code": "600315705",
"telephone_number": "847-599-9171",
"fax_number": "847-599-9124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 S GREENLEAF ST",
"address_2": "SUITE 101",
"city": "GURNEE",
"state": "IL",
"postal_code": "600315705",
"telephone_number": "847-599-9171",
"fax_number": "847-599-9124"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CREATIVE REHAB, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-07",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "DAVIDSON",
"authorized_official_first_name": "ANITA",
"authorized_official_title_or_position": "OWNNER",
"authorized_official_telephone_number": "847-599-9171",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gurnee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.