NPIMap

Organization Active NPI

Premiere Physical Therapy & Sport Rehabilitation

  • Physical Therapist
  • Springfield, IL
National Provider Identifier
1477660629
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMIERE PHYSICAL THERAPY & SPORT REHABILITATION
Practice address
320 E Carpenter St Ste 1B
Springfield, IL 62702-5165
Phone
(217) 744-8000
Fax
(217) 744-8004
NPI assigned
Aug 24, 2006
Last updated
Sep 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Authorized official

Name
John A WoodardNPI 1396856779
Title
PT/Ceo
Phone
(217) 744-8000

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 NU Primary

Addresses

Primary practice location

320 E Carpenter St Ste 1B
Springfield, IL 62702-5165

Mailing address

320 E Carpenter St Ste 1B
Springfield, IL 62702-5165
Phone (217) 744-8000

Other identifiers 1

IdentifierTypeStateIssuer
8421396OtherILBCBS GROUP

National Provider Directory

National Provider Directory

Locations

1134 Commercial Ct
Chatham, IL 62629
Phone (217) 483-4300

320 E Carpenter St
Ste 1B
Springfield, IL 62702
Phone (217) 744-8000

1226 N Springfield St
Virden, IL 62690
Phone (217) 965-5100

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1477660629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E CARPENTER ST STE 1B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025165",
            "telephone_number": "217-744-8000",
            "fax_number": "217-744-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E CARPENTER ST STE 1B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025165",
            "telephone_number": "217-744-8000",
            "fax_number": "217-744-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE PHYSICAL THERAPY & SPORT REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PT/CEO",
        "authorized_official_telephone_number": "217-744-8000"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "8421396",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.