Basic Information
| Provider Information | |||||||||
| NPI: | 1417120635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGFIELD CLINIC PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 S 6TH ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627032416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175287541 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 N 1ST ST | ||||||||
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| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627023719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175287541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2008 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | NERONE | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 2175287541 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPRINGFIELD CLINIC LLP | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.