NPIMap

Organization Active NPI

Rock Valley Physical Therapy Center

  • Physical Therapist
  • Moline, IL
National Provider Identifier
1104056548
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ROCK VALLEY PHYSICAL THERAPY CENTER
Practice address
4439 Avenue of the Cities
Moline, IL 61265-4549
Phone
(309) 743-0106
NPI assigned
Jul 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

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

Authorized official

Name
Randy E Boldt, P.T.
Title
Cfo
Phone
(309) 743-2070

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X IL Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X IL

Addresses

Primary practice location

4439 Avenue of the Cities
Moline, IL 61265-4549

Mailing address

850 43Rd Ave
Suite 100
Moline, IL 61265-8401
Phone (309) 743-2070

Other identifiers 2

IdentifierTypeStateIssuer
555650OtherILGROUP BILLING # FOR O.T,
555640OtherILGROUP BILLING # FOR P.T.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1104056548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 43RD AVE",
            "address_2": "SUITE 100",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658401",
            "telephone_number": "309-743-2070",
            "fax_number": "309-743-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4439 AVENUE OF THE CITIES",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612654549",
            "telephone_number": "309-743-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK VALLEY PHYSICAL THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-20",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "BOLDT",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "309-743-2070",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BILLING # FOR O.T,",
            "identifier": "555650",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BILLING # FOR P.T.",
            "identifier": "555640",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.