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Organization
PREMIERE PHYSICAL THERAPY & SPORTS INJURY REHABILITATION LLC
Active
Organization
PREMIERE PHYSICAL THERAPY & SPORTS INJURY REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WOODARD (CEO/PHYSICAL THERAPIST)
(217) 744-8000
Entity
Organization
Contact information
Practice address
2901 OLD JACKSONVILLE RD STE C, SPRINGFIELD, IL 62704-7437
(217) 793-0000
Mailing address
2901 OLD JACKSONVILLE RD STE C, SPRINGFIELD, IL 62704-7437
(217) 793-0000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8421396
BCBS
IL
Enumeration date
10/05/2009
Last updated
10/05/2009
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