River Valley Physical Therapy Spine and Joint Center LLC
Organization Active NPI Physical Therapist · Bradley, IL
NPI 1144401233 · NPPES record last updated Nov 17, 2015
Key facts
- NPI
- 1144401233
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- RIVER VALLEY PHYSICAL THERAPY SPINE AND JOINT CENTER LLC
- Practice address
- 517 E North St
Bradley, IL 60915-1258 - Phone
- (815) 802-7503
- Fax
- (815) 802-7514
- NPI assigned
- Nov 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Gerard Breuker, PT, MSC
- Title
- Member
- Phone
- (815) 802-7503
Practitioners 9
-
Gerard Breuker, PT, DPT
-
Kelly Marie Bufford, PT ATC
-
Melissa Hyma, PT, MPT
-
Michelle Zabin, OTR/L
-
Denise Lynn Cannon, LMT
-
Amy J Green, R.P.T.
-
Laura Carpenter, PTA, LMT
-
Carla Schimmelpfennig, P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080308000048 | IL | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 8426133950 |
Receives reassigned benefits from 4 practitioners Practice locations: Peotone, IL; Clifton, IL; Bradley, IL |
| O20250409000123 | IL | DME Supplier - Independently-Practicing Occupational Therapist | 8426133950 | Practice locations: Bradley, IL |
National Provider Directory
Locations
535 E North St
Ste C
Bradley, IL 60915
Phone (815) 802-7503
517 E North St
Bradley, IL 60915
Phone (815) 802-7503
341 S Main St
Clifton, IL 60927
Phone (815) 918-5084
422 S Governors Hwy
Ste 4
Peotone, IL 60468
Phone (708) 792-0044
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
517 E North St
Bradley, IL 60915-1258
Mailing address
517 E North St
Bradley, IL 60915-1258
Phone (815) 802-7503
Other providers in Bradley, IL
- Cynthia Ann Provost
- Rajeev Damian Puri
- Riegel Chiropractic LLC
- Elizabeth Rieger
- River North of Bradley Health and Rehabilitation Center LLC
- Riverside Corporate Health Services
- Riverside Medical Center
- Latonjanette Robertson
- Stephanie Erin Robertson
- Evelyn Rodriguez
All providers in Bradley, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.