NPIMap

Organization Active NPI

HR Physical Therapy , Sports & Industrial Rehabilitation PC

  • Orthopedic Physical Therapist
  • Herrin, IL
National Provider Identifier
1265474555
Registry record updated Mar 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
070004717 Issued in IL
Legal business name
HR PHYSICAL THERAPY , SPORTS & INDUSTRIAL REHABILITATION PC
Practice address
3308 Logan Dr
Herrin, IL 62948-3759
Phone
(618) 993-4024
Fax
(618) 993-1570
NPI assigned
Jun 12, 2006
Last updated
Mar 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2009

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

Authorized official

Name
Laura L Roach, PTNPI 1164591020
Title
President
Phone
(618) 993-4024

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 070004717 IL Primary
Orthopedic Physical Therapist 2251X0800X 070007595 IL
Orthopedic Physical Therapist 2251X0800X 070014266 IL

Addresses

Primary practice location

3308 Logan Dr
Herrin, IL 62948-3759

Mailing address

3308 Logan Dr
Herrin, IL 62948-3759
Phone (618) 993-4024

Other identifiers 3

IdentifierTypeStateIssuer
344647789001MedicaidIL
3467499841001MedicaidIL
484800286001MedicaidIL

Other names 1

  • Heartland Rehabilitation Former legal business name

National Provider Directory

National Provider Directory

Locations

3308 Logan Dr
Herrin, IL 62948
Phone (618) 993-4024

400 Lou Ann Dr
Herrin, IL 62948
Phone (618) 993-4024

103 Airway Dr
Ste 2
Marion, IL 62959
Phone (618) 997-5727

Practitioners & affiliated clinicians

Practitioners 5

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": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236556800000",
    "number": "1265474555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 LOGAN DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483759",
            "telephone_number": "618-993-4024",
            "fax_number": "618-993-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3308 LOGAN DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483759",
            "telephone_number": "618-993-4024",
            "fax_number": "618-993-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HR PHYSICAL THERAPY , SPORTS & INDUSTRIAL REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2009-03-09",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-993-4024",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070004717",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070007595",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070014266",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344647789001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3467499841001",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "484800286001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Rehabilitation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Herrin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; 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.