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Organization
ROSCOE PHYSICAL THERAPY, INC
Active
Organization
ROSCOE PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES WILLIAM MCKINLEY P.T. (PRESIDENT)
(815) 623-9700
Entity
Organization
Contact information
Practice address
5003 HONONEGAH RD, ROSCOE, IL 61073-8682
(815) 623-9700
(815) 623-9722
Mailing address
5003 HONONEGAH RD, ROSCOE, IL 61073-8682
(815) 623-9700
(815) 623-9722
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10132155
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/18/2007
Last updated
08/22/2020
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