Provider Demographics
NPI:1871831388
Name:ADVANCE PHYSICAL THERAPY ILLINI COMMUNITY HOSPITAL LLC
Entity type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY ILLINI COMMUNITY HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-222-6800
Mailing Address - Street 1:160 PROGRESS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6630
Mailing Address - Country:US
Mailing Address - Phone:573-600-6540
Mailing Address - Fax:573-600-6541
Practice Address - Street 1:201 N MISSISSIPPI ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1410
Practice Address - Country:US
Practice Address - Phone:217-285-4512
Practice Address - Fax:217-285-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2025-04-16
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