Pediatric Physical Therapy of Central Illinois LTD

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PEDIATRIC PHYSICAL THERAPY OF CENTRAL ILLINOIS LTD

Practice address

123 W William Street
Monticello, IL 61856

Phone

(217) 840-3915

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Susan H Gibson, PT

Title

Physical Therapist Owner

Phone

(217) 840-3915

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104959998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211",
            "address_2": "123 W WILLIAM STREET",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "61856",
            "telephone_number": "217-840-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W WILLIAM STREET",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "61856",
            "telephone_number": "217-840-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PHYSICAL THERAPY OF CENTRAL ILLINOIS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST OWNER",
        "authorized_official_telephone_number": "217-840-3915",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Monticello, IL
• Providers in Monticello, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.