NPIMap

Organization Active NPI

Granite City Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Granite City, IL
National Provider Identifier
1649664277
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
070018656 Issued in IL
Legal business name
GRANITE CITY PHYSICAL THERAPY LLC
Practice address
400 A St Ste D
Granite City, IL 62040-1891
Phone
(618) 452-8561
NPI assigned
Mar 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Authorized official

Name
Jesse Moore, DPTNPI 1043555410
Title
Owner
Phone
(317) 691-6262

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 Therapy Clinic/Center 261QP2000X 070018656 IL Primary

Addresses

Primary practice location

400 A St Ste D
Granite City, IL 62040-1891

Mailing address

3008 Huntsville Dr
Glen Carbon, IL 62034-3046
Phone (317) 691-6262

National Provider Directory

National Provider Directory

Locations

400 A St
Ste D
Granite City, IL 62040
Phone (618) 452-8561

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1649664277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 HUNTSVILLE DR",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343046",
            "telephone_number": "317-691-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 A ST STE D",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620401891",
            "telephone_number": "618-452-8561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE CITY PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-691-6262",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070018656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.