| Organization Name: | CENTRAL ILLINOIS PHYSICAL THERAPY PROFESSIONALS, LTD |
| NPI Number: | 1124246939 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD W KRUCKEBERG (PHYSICAL THERAPIST EXECUTIVE DIRECT) |
| Mailing Address: | 100 Professional Plz Mattoon |
| State: | IL US |
| Postal Code: | 619389252 |
| Phone Number: | 2173451245 |
| Fax Number: | 2173451253 |
| NPI Enumeration Date: | 04/24/2007 |
| NPI Last Update Date: | 04/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070002766 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |