Provider Demographics
NPI:1043971336
Name:REHABILITATION SPECIALIST OF SOUTHERN ILLINOIS PLLC
Entity type:Organization
Organization Name:REHABILITATION SPECIALIST OF SOUTHERN ILLINOIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SABATINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-680-5542
Mailing Address - Street 1:4225 LINCOLNSHIRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2157
Mailing Address - Country:US
Mailing Address - Phone:618-242-2317
Mailing Address - Fax:618-242-9710
Practice Address - Street 1:2351 FRANK SCOTT PKWY E
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7457
Practice Address - Country:US
Practice Address - Phone:618-242-2317
Practice Address - Fax:618-242-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty