# ADVANCED REHAB SPORTS MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Rehab Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235121393
- **Authorized official:** MARK STEVEN OERTWIG (DIRECTOR OF FINANCE)
- **Authorized official phone:** (309) 661-8823

## Contact information

- **Practice address:** 1201 E BROADWAY, SUITE C, MONMOUTH, IL 61462-1994
- **Practice address phone:** (309) 734-1103
- **Practice address fax:** (309) 734-2013
- **Mailing address:** PO BOX 5387, BLOOMINGTON, IL 61702-5387
- **Mailing address phone:** (309) 661-8823
- **Mailing address fax:** (309) 661-8801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | IL | Yes |
| 225X00000X | Occupational Therapist | — | IL | — |
| 235Z00000X | Speech-Language Pathologist | — | IL | — |

## Other

- **Enumeration date:** 08/16/2005
- **Last updated:** 11/03/2022