Provider Demographics
NPI:1871931840
Name:KRS SPORTS MEDICINE AND REHABILITATION, SC
Entity type:Organization
Organization Name:KRS SPORTS MEDICINE AND REHABILITATION, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-228-6689
Mailing Address - Street 1:237 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1880
Mailing Address - Country:US
Mailing Address - Phone:708-228-6689
Mailing Address - Fax:
Practice Address - Street 1:1749 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5877
Practice Address - Country:US
Practice Address - Phone:312-440-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.123210208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty