Organization
BELVIDERE REHAB & SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A BLACK PT, MS, OCS (OWNER/EXECUTIVE OFFICER)
(815) 227-1700
Entity
Organization
Contact information
Practice address
1255 LOGAN AVE, BELVIDERE, IL 61008-4001
(815) 547-4733
(815) 547-9733
Mailing address
2662 MCFARLAND RD, ROCKFORD, IL 61107-6806
(815) 547-4733
(815) 547-9733
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
060-008176
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060-008176
PROFESSIONAL LICENSE
IL
Enumeration date
05/23/2006
Last updated
01/08/2013
Update your record
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