AGE REHAB & MEDICAL FITNESS (NPI# 1184188443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184188443 |
| Entity Type | Organization |
| Organization Name | AGE REHAB & MEDICAL FITNESS |
| Practice Address |
1701 W Jackson St Ste C Macomb IL 61455-3175 |
| Practice Telephone | 3093313590 |
| Mailing Telephone | 3093313590 |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-01-30 |
| Authorized Official Name | DR. VICTOR E LIDAYWA (PHYSICAL THERAPIST) |
| Authorized Official Telephone | 3093313590 |
| Authorized Official Credential | DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Age Rehab | Doing Business As Name - Organization |
| Street Address |
1701 W JACKSON ST STE C |
| City | MACOMB |
| State | IL |
| Zip Code | 61455-3175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043869944 | Wesley Village, Inc | Speech-Language Pathologist | 1200 East Grant Street, Macomb, IL 61455 | 2019-09-04 |
| 1780154013 | Hannah Lauren Bengtson | Optometrist | 820 E. Jackson St., Macomb, IL 61455 | 2018-11-29 |
| 1255832564 | Lifeguard Ambulance Service of Illinois Inc. | Ambulance | 219 W Jackson St, Macomb, IL 61455 | 2018-02-22 |
| 1821516816 | Michelle Deann Sargeant | Speech-Language Pathologist | 315 N. Bonham, Macomb, IL 61455 | 2017-08-30 |
| 1972020360 | Kara Marie Wright | Speech-Language Pathologist | 315 N. Bonham St., Macomb, IL 61455 | 2017-08-25 |
| 1720356504 | Dawn M. Kedzior | Social Worker | 103 South Johnson Street, Macomb, IL 61455 | 2011-12-07 |
| 1255632642 | Michael Kurt Sharp | Audiologist | Memorial Hall, Second Floor, W Murray St, Macomb, IL 61455 | 2010-11-16 |
| 1952538704 | Mary L. Smith | Developmental Therapist | 1 University Circle, Western Il Univ, Cntr for Best Practices In Early Childhood Education, Macomb, IL 61455 | 2009-06-19 |
| 1982857827 | Macomb Oncology Institute Ltd | Radiology | 401 East Grant Street, Macomb, IL 61455 | 2008-10-23 |
| 1245488345 | Sonja E Schmidt | Social Worker | 119 Wetzel Hall, Western Illinois University, Macomb, IL 61455 | 2008-09-03 |
| Find all providers in zip 61455 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144515768 | G N Therapy, PC | Clinic/Center | 55264 Nile Way, Macomb, MI 48042-6194 | 2011-06-11 |
| 1811980162 | Complete Rehab Services, Inc | Clinic/Center | 51226 Romeo Plank, Macomb, MI 48042 | 2005-08-23 |
| 1487067260 | Seton Health Corporation of Southeastern Michigan | Clinic/Center | 17900 23 Mile Rd, Suite 401, Macomb, MI 48044-1161 | 2014-06-09 |
| 1750527438 | Vms of Macomb Twp LLC | Clinic/Center | 23211 21 Mile Rd, Macomb, MI 48042 | 2008-12-30 |
| 1063624757 | Medical Resources Group | Clinic/Center | 17900 23 Mile Rd, Suite 401, Macomb, MI 48044-1161 | 2007-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831790336 | Priority You Physical Therapy and Wellness, Pllc | Clinic/Center | 20660 Caton Farm Rd., Unit A, Crest Hills, IL 60403 | 2020-11-03 |
| 1487253464 | Chimera Health Pllc | Clinic/Center | 525 N Ada St Apt 10, Chicago, IL 60642-6486 | 2020-10-21 |
| 1528666468 | Chicago Pelvic Health and Wellness, LLC | Clinic/Center | 1020 E Ogden Ave Ste 309, Naperville, IL 60563-8611 | 2020-10-13 |
| 1548876063 | Midwest Orthopaedics At Rush, LLC | Clinic/Center | 1000 Commerce Court, Suite 101, Bensenville, IL 60106 | 2020-09-21 |
| 1518573963 | Better Play Performance & Rehab Pllc | Clinic/Center | 1201 Waters Edge Rd, Champaign, IL 61822-8101 | 2020-09-21 |
| 1548876329 | Midwest Orthopaedics At Rush, LLC | Clinic/Center | 17130 Prime Blvd Ste 101, Lockport, IL 60441-1311 | 2020-09-17 |
| 1124631676 | Leena Bird Physical Therapy Pllc | Clinic/Center | 400 Prairie Knoll Dr, Naperville, IL 60565-4154 | 2020-08-25 |
| 1831702232 | Pararmount Physical Therapy LLC | Clinic/Center | 2960 Artesian Rd Ste 152, Naperville, IL 60564-4876 | 2020-08-25 |
| 1487263851 | Priority You Physical Therapy and Wellness Pllc | Clinic/Center | 2101 Alpine Way, Plainfield, IL 60586-5079 | 2020-07-30 |
| 1093324345 | Motogenix Concierge Physical Therapy | Clinic/Center | 111 S Morgan St Apt 620, Chicago, IL 60607-2732 | 2020-07-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.