Provider Demographics
NPI:1740279835
Name:TWIN RIVERS PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:TWIN RIVERS PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-797-8778
Mailing Address - Street 1:1050 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7126
Mailing Address - Country:US
Mailing Address - Phone:309-797-8778
Mailing Address - Fax:309-797-8072
Practice Address - Street 1:1050 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7126
Practice Address - Country:US
Practice Address - Phone:309-797-8778
Practice Address - Fax:309-797-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
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
IL08130333OtherBLUE CROSS BLUE SHIELD
IL213048Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY
IL213049Medicare ID - Type UnspecifiedPHYSICAL THERAPY