Organization
HR PHYSICAL THERAPY , SPORTS & INDUSTRIAL REHABILITATION PC
Active
Other names
Heartland Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA L ROACH PT (PRESIDENT)
(618) 993-4024
Entity
Organization
Contact information
Practice address
3308 LOGAN DR, HERRIN, IL 62948-3759
(618) 993-4024
(618) 993-1570
Mailing address
3308 LOGAN DR, HERRIN, IL 62948-3759
(618) 993-4024
(618) 993-1570
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
070004717
IL
2251X0800X
Orthopedic Physical Therapist
070007595
IL
2251X0800X
Orthopedic Physical Therapist
070014266
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344647789001
—
IL
05
—
3467499841001
—
IL
05
—
484800286001
—
IL
Enumeration date
06/12/2006
Last updated
03/09/2009
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