Provider Demographics
NPI:1811948201
Name:JOYNER THERAPY SERVICES
Entity type:Organization
Organization Name:JOYNER THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOYNER
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:618-998-9894
Mailing Address - Street 1:2907 WILLIAMSON COUNTY PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5256
Mailing Address - Country:US
Mailing Address - Phone:618-998-9894
Mailing Address - Fax:618-998-9993
Practice Address - Street 1:217 S. ADAMS
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62629
Practice Address - Country:US
Practice Address - Phone:618-683-2728
Practice Address - Fax:618-683-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL325688945001Medicaid
IL347640449001Medicare ID - Type UnspecifiedCHERI PHILLIPS
IL360702405001Medicare ID - Type UnspecifiedJAMI THOMAS
ILDE2632Medicare ID - Type UnspecifiedMEDICARE RR GROUP
IL212384Medicare ID - Type UnspecifiedPHYSICAL THERAPY GROUP
IL325688945001Medicaid
IL318540756001Medicare ID - Type UnspecifiedBRIAN JOYNER