Organization
PHYSICAL THERAPISTS CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERYL DIANE BARBER (INSURANCE MANAGER)
(217) 245-1325
Entity
Organization
Contact information
Practice address
1440 W WALNUT ST, SUITE2, JACKSONVILLE, IL 62650-1143
(217) 245-1325
(217) 243-6903
Mailing address
1440 W WALNUT ST, SUITE2, JACKSONVILLE, IL 62650-1143
(217) 245-1325
(217) 243-6903
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203000094
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005415281
BCBS
IL
05
—
1558480418
—
IL
Enumeration date
01/24/2007
Last updated
05/02/2008
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