Organization
MEMORIAL INDUSTRIAL REHABILITATION OF JACKSONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT T CLARKE (PRESIDENT AND CEO)
(217) 788-3340
Entity
Organization
Contact information
Practice address
901 W MORTON AVE, SUITE 16A, JACKSONVILLE, IL 62650-3146
(217) 245-4640
(217) 245-4642
Mailing address
901 W MORTON AVE, SUITE 16A, JACKSONVILLE, IL 62650-3146
(217) 245-4640
(217) 245-4642
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06932016
BCBS GROUP NUMBER
—
Enumeration date
03/27/2006
Last updated
09/11/2025
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