Family Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070006904 Issued in IL

Legal business name

FAMILY PHYSICAL THERAPY, LLC

Practice address

103 N Main St
Port Byron, IL 61275-7705

Phone

(309) 523-2949

NPI assigned

Sep 19, 2013

Last updated

Sep 19, 2013By 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

Mr. Robert Stanley Johannsen, PT

Title

Physical Therapist/Owner

Phone

(309) 523-2949

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1174959340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 125",
            "address_2": "103 NORTH MAIN STREET",
            "city": "PORT BYRON",
            "state": "IL",
            "postal_code": "612757703",
            "telephone_number": "309-523-2949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N MAIN ST",
            "city": "PORT BYRON",
            "state": "IL",
            "postal_code": "612757705",
            "telephone_number": "309-523-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "JOHANNSEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "309-523-2949",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070006904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bull Clinic P.C.
• David Lee Bull, DC
• Peter D Crocker, D.C.
• Sydney Christine Delgadillo, DMD
• Galva Family Dentistry, Inc. (Port Byron Family Dentistry)
• Genesis Health System (Genesis Health Group)
• Barbara Ann Gillman, DT
• Gregory L Glade, DMD
• Sarah Lynn Goodson, LCSW

• Physical Therapist in Port Byron, IL
• Providers in Port Byron, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; 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.