OrganizationPremiere Physical Therapy & Sports Injury Rehabilitation LlcPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2901 Old Jacksonville Rd Ste C, Springfield, IL 62704-7437(217) 793-0000PECOS EnrollmentBased on the most recent information from CMS, provider Premiere Physical Therapy & Sports Injury Rehabilitation Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1053646398Provider TypeOrganizationFull NamePremiere Physical Therapy & Sports Injury Rehabilitation LlcSubpartNoEnumeration Date10/5/2009Last Updated10/5/2009Contact InformationPractice LocationPractice Address2901 Old Jacksonville Rd Ste C, Springfield, IL 62704-7437Phone(217) 793-0000FaxUnlisted FaxMailing LocationMailing Address2901 Old Jacksonville Rd Ste C, Springfield, IL 62704-7437Phone(217) 793-0000FaxUnlisted FaxAuthorized OfficialNameWoodard, John (Ceo/Physical Therapist)Phone(217) 744-8000Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID8421396DescriptionOtherIssuerBCBSIllinois