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Organization
PREMIERE PHYSICAL THERAPY & SPORT REHABILITATION
Active
Organization
PREMIERE PHYSICAL THERAPY & SPORT REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A WOODARD (PT/CEO)
(217) 744-8000
Entity
Organization
Contact information
Practice address
320 E CARPENTER ST STE 1B, SPRINGFIELD, IL 62702-5165
(217) 744-8000
(217) 744-8004
Mailing address
320 E CARPENTER ST STE 1B, SPRINGFIELD, IL 62702-5165
(217) 744-8000
(217) 744-8004
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8421396
BCBS GROUP
IL
Enumeration date
08/24/2006
Last updated
09/30/2009
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