NPIMap

Organization Active NPI

R.a. Physical Therapy, PC

  • Physical Therapist
  • Gibson City, IL
National Provider Identifier
1174578157
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
R.A. PHYSICAL THERAPY, PC
Practice address
109 N Sangamon Ave
Gibson City, IL 60936-1342
Phone
(217) 784-8033
Fax
(217) 784-8077
NPI assigned
May 24, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Rhodora Bautista Astronomo, PTNPI 1386691426
Title
President
Phone
(217) 784-8033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X IL Primary

Addresses

Primary practice location

109 N Sangamon Ave
Gibson City, IL 60936-1342

Mailing address

109 N Sangamon Ave
Gibson City, IL 60936-1342
Phone (217) 784-8033

Other identifiers 1

IdentifierTypeStateIssuer
319929929001MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1174578157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N SANGAMON AVE",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361342",
            "telephone_number": "217-784-8033",
            "fax_number": "217-784-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N SANGAMON AVE",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361342",
            "telephone_number": "217-784-8033",
            "fax_number": "217-784-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R.A. PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ASTRONOMO",
        "authorized_official_first_name": "RHODORA",
        "authorized_official_middle_name": "BAUTISTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-784-8033",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "319929929001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gibson City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.