Wilderness Performance Therapy & Strength Training, LLC.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

WILDERNESS PERFORMANCE THERAPY & STRENGTH TRAINING, LLC.

Practice address

1823 Ness Way
Montgomery, IL 60538-4073

Phone

(309) 287-2509

NPI assigned

Aug 12, 2019

Organization subpart

No

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

Authorized official

Name

Justin Wilhoit

Title

Manager

Phone

(312) 884-1190

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588032000000",
    "number": "1639725104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1823 NESS WAY",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605384073",
            "telephone_number": "309-287-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 NESS WAY",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605384073",
            "telephone_number": "309-287-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS PERFORMANCE THERAPY & STRENGTH TRAINING, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-12",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A",
        "authorized_official_last_name": "WILHOIT",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "312-884-1190"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Montgomery, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; 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.