Central Illinois Physical Therapy Professionals, LTD

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070002766 Issued in IL

Legal business name

CENTRAL ILLINOIS PHYSICAL THERAPY PROFESSIONALS, LTD

Practice address

2 E Harrison St
Sullivan, IL 61951-1905

Phone

(217) 345-1245

Fax

(217) 345-1253

NPI assigned

Apr 24, 2007

Last updated

Dec 10, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Richard Warren Kruckeberg, PTNPI 1245362920

Title

Owner

Phone

(217) 345-1245

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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.

• Richard Warren Kruckeberg, P.T., O.C.S., C.H.T.

  • Physical Therapist
  • Mattoon, IL
  • NPI 1245362920
  Medicare reassignment NPD Authorized official
• Mark Masse, PT, MHS

  • Physical Therapist
  • Mattoon, IL
  • NPI 1801912167
  NPD (past)
• Aaron Whitbeck Perkins, D.C, PT

  • Physical Therapist
  • Plattsburgh, NY
  • NPI 1184695439
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765324800000",
    "number": "1124246939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 101",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619510101",
            "telephone_number": "217-345-1245",
            "fax_number": "855-509-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 E HARRISON ST",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619511905",
            "telephone_number": "217-345-1245",
            "fax_number": "217-345-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS PHYSICAL THERAPY PROFESSIONALS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A",
        "authorized_official_last_name": "KRUCKEBERG",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-345-1245",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070002766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Brumfield
• Brett Bryden, BS, MHP
• Faisal Bukhari, MD SC
• Patricia E Carr, FNP
• Tabitha Jean Centers, BCBA
• Holly Renee Clemons, M.D.
• David L Cole, LCSW, LPHA
• Community Homecare Inc
• Tatum Copsy, BS
• County of Moultrie (Sullivan Fire Ambulance District)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.