Provider Demographics
NPI:1558480418
Name:PHYSICAL THERAPISTS CLINIC,LTD
Entity Type:Organization
Organization Name:PHYSICAL THERAPISTS CLINIC,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-245-1455
Mailing Address - Street 1:1440 W WALNUT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1143
Mailing Address - Country:US
Mailing Address - Phone:217-245-1455
Mailing Address - Fax:217-243-6903
Practice Address - Street 1:1440 W WALNUT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1143
Practice Address - Country:US
Practice Address - Phone:217-245-1455
Practice Address - Fax:217-243-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141-989OtherHEALTHLINK
IL0005415281OtherBCBS
IL0179880001Medicare NSC
IL0005415281OtherBCBS