Provider Demographics
NPI:1609622158
Name:MIDWEST PERFORMANCE REHAB, PLLC
Entity type:Organization
Organization Name:MIDWEST PERFORMANCE REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VANT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:630-809-9838
Mailing Address - Street 1:7212 N PECATONICA RD
Mailing Address - Street 2:
Mailing Address - City:LEAF RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:61047-9402
Mailing Address - Country:US
Mailing Address - Phone:630-809-9838
Mailing Address - Fax:
Practice Address - Street 1:7212 N PECATONICA RD
Practice Address - Street 2:
Practice Address - City:LEAF RIVER
Practice Address - State:IL
Practice Address - Zip Code:61047-9402
Practice Address - Country:US
Practice Address - Phone:630-809-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy