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Organization Active NPI

Kewanee Physical Therapy and Rehab Specialists LLC

  • Occupational Therapist
  • Kewanee, IL
National Provider Identifier
1629081906
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
KEWANEE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
Practice address
1258 W South St
Suite 1
Kewanee, IL 61443-8300
Phone
(866) 932-5400
Fax
(309) 932-8105
NPI assigned
Aug 15, 2006
Last updated
Jun 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

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

Authorized official

Name
Larry D Briand
Title
Co-Owner
Phone
(877) 552-2996

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070009875 IL
Occupational Therapist 225X00000X Primary

Addresses

Primary practice location

1258 W South St
Suite 1
Kewanee, IL 61443-8300

Mailing address

PO Box 3497
Sturtevant, WI 53177-3497
Phone (877) 552-2996

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040930001065 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3971572470 Receives reassigned benefits from 3 practitioners
Practice locations: Galva, IL; Kewanee, IL; Wyoming, IL

National Provider Directory

National Provider Directory

Locations

356 Front St
Galva, IL 61434
Phone (309) 932-8100

110 E 10th St
Kewanee, IL 61443
Phone (309) 852-2200

110 E 10th St
Ste 1
Kewanee, IL 61443

125 W South St
Ste B
Kewanee, IL 61443
Phone (309) 852-2200

1258 W South St
Ste 1
Kewanee, IL 61443
Phone (309) 852-2200

112 E Williams St
Wyoming, IL 61491
Phone (309) 695-4010

Practitioners & affiliated clinicians

Practitioners 9

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": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1629081906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3497",
            "city": "STURTEVANT",
            "state": "WI",
            "postal_code": "531773497",
            "telephone_number": "877-552-2996",
            "fax_number": "866-245-8064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1258 W SOUTH ST",
            "address_2": "SUITE 1",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614438300",
            "telephone_number": "866-932-5400",
            "fax_number": "309-932-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEWANEE PHYSICAL THERAPY AND REHAB SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "BRIAND",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "877-552-2996"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070009875",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kewanee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.