NPIMap

Organization Active NPI

Belvidere Physical Therapy Inc

Doing business as CORA Physical Therapy - Belvidere

  • Rehabilitation Clinic/Center
  • Belvidere, IL
National Provider Identifier
1083719033
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
BELVIDERE PHYSICAL THERAPY INC
Doing business as
CORA Physical Therapy - Belvidere
Practice address
1686 Henry Luckow LN
Belvidere, IL 61008
Phone
(815) 547-4777
Fax
(815) 547-1024
NPI assigned
Sep 14, 2006
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Stephen Krzminski
Title
Executive Vice President
Phone
(419) 221-6717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

1686 Henry Luckow LN
Belvidere, IL 61008

Mailing address

PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717

Other names 1

  • CORA Physical Therapy - Belvidere Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191210000682 IL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 4082645932 Practice locations: Belvidere, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083719033. Details of each certification follow.

  • CCN 146768 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 146768

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CORA PHYSICAL THERAPY - BELVIDERE
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jun 3, 2020
Last certification
Jun 3, 2020
Ownership / control type
Proprietary
Facility address
1686 Henry Luckow LN
Belvidere, IL 61008

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1686 Henry Luckow Ln
Belvidere, IL 61008
Phone (815) 547-4777

522 S State St
Belvidere, IL 61008
Phone (815) 547-4777

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1083719033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020150",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 HENRY LUCKOW LN",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "61008",
            "telephone_number": "815-547-4777",
            "fax_number": "815-547-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELVIDERE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "KRZMINSKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "419-221-6717",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Belvidere",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belvidere, IL

Sources for this page

Verify at the official NPI Registry.