| Organization Name: | BELVIDERE REHAB & SPORTS MEDICINE |
| NPI Number: | 1619922515 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID A BLACK (OWNER/EXECUTIVE OFFICER) |
| Mailing Address: | 1255 Logan Ave Belvidere |
| State: | IL US |
| Postal Code: | 610084001 |
| Phone Number: | 8155474733 |
| Fax Number: | 8155479733 |
| NPI Enumeration Date: | 05/23/2006 |
| NPI Last Update Date: | 01/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 060-008176 |
| 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 |