Provider Demographics
NPI:1942429097
Name:LINCOLNLAND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LINCOLNLAND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:217-787-5578
Mailing Address - Street 1:536 N BRUNS LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4667
Mailing Address - Country:US
Mailing Address - Phone:217-787-5578
Mailing Address - Fax:217-787-5595
Practice Address - Street 1:536 N BRUNS LN
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4667
Practice Address - Country:US
Practice Address - Phone:217-787-5578
Practice Address - Fax:217-787-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL133443OtherHEALTHLINK
IL0008415017OtherBLUE CROSS
IL36034OtherPERSONAL CARE
IL0008415017OtherBLUE CROSS