NPIMap

Organization Active NPI

Physical Therapy Center LTD

  • Physical Therapist
  • Bourbonnais, IL
National Provider Identifier
1487639423
Registry record updated Nov 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
060005773 Issued in IL
Legal business name
PHYSICAL THERAPY CENTER LTD
Practice address
1230 N Convent St
A
Bourbonnais, IL 60914-1006
Phone
(815) 935-8782
Fax
(815) 835-8799
NPI assigned
Dec 13, 2005
Last updated
Nov 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2012

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

Authorized official

Name
Judith Marie Landrebe, PTNPI 1609899202
Title
Owner PT
Phone
(815) 935-8782

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 060005773 IL Primary

Addresses

Primary practice location

1230 N Convent St
A
Bourbonnais, IL 60914-1006

Mailing address

1230 N Convent St
A
Bourbonnais, IL 60914-1006
Phone (815) 935-8782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051229000222 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8628090024 Receives reassigned benefits from 2 practitioners
Practice locations: Bourbonnais, IL

National Provider Directory

National Provider Directory

Locations

1221 N Convent St
Bourbonnais, IL 60914
Phone (815) 935-8782

1230 N Convent St
Ste A
Bourbonnais, IL 60914
Phone (815) 935-8782

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": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353283200000",
    "number": "1487639423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 N CONVENT ST",
            "address_2": "A",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141006",
            "telephone_number": "815-935-8782",
            "fax_number": "815-835-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 N CONVENT ST",
            "address_2": "A",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141006",
            "telephone_number": "815-935-8782",
            "fax_number": "815-835-8799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2012-11-19",
        "status": "A",
        "authorized_official_last_name": "LANDREBE",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER PT",
        "authorized_official_telephone_number": "815-935-8782",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "060005773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.