| King Spinal & Sports Rehabilitation, Ltd. | |
|
1525 Johnson Rd, Granite City, IL 62040-3831 | |
| (618) 452-1986 | |
| (618) 452-6814 |
| Full Name | King Spinal & Sports Rehabilitation, Ltd. |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 1525 Johnson Rd, Granite City, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427157593 | NPI | - | NPPES |
| 06032044 | Other | BC/BS OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | (Illinois) | Primary |
| 225100000X | Physical Therapist | (Illinois) | Primary |
| Provider Name | Charles E King |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1285733360 PECOS PAC ID: 1153330121 Enrollment ID: I20060419000642 |
| Provider Name | Larry D Hawkins |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437115045 PECOS PAC ID: 2466412358 Enrollment ID: I20061211000077 |
| Provider Name | Susan R Holt |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386787406 PECOS PAC ID: 8022181486 Enrollment ID: I20080717000362 |
| Provider Name | Krista L Gooding |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1841805058 PECOS PAC ID: 9032521513 Enrollment ID: I20201208001577 |
| Mailing Address | Practice Location Address |
|---|---|
| King Spinal & Sports Rehabilitation, Ltd. Po Box 1343, Granite City, IL 62040-1343 Ph: (618) 452-1986 | King Spinal & Sports Rehabilitation, Ltd. 1525 Johnson Rd, Granite City, IL 62040-3831 Ph: (618) 452-1986 |
Mr. Walter P Griffith, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2100 Madison Ave, Granite City, IL 62040 Phone: 618-798-3000 | |
Melanie M Kozak, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2100 Madison Ave, Granite City, IL 62040 Phone: 618-798-3135 Fax: 618-798-3140 | |
Miss Jenna Anne Davis, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1503 Lindell Blvd, Granite City, IL 62040 Phone: 618-709-4125 Fax: 618-709-4126 | |
Mr. Timothy J Knox, PT, CHT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1700 Walnut St, Granite City, IL 62040 Phone: 618-452-2111 Fax: 618-225-6417 | |
Mr. Ilde Boy Tan Velasco, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3500 Century Dr, Granite City, IL 62040 Phone: 618-877-2700 | |
Mrs. Carla Ann Buzan, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2100 Madison Ave, Granite City, IL 62040 Phone: 618-798-3135 Fax: 618-798-3505 | |
Dr. Michael Lockenvitz, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 1503 Lindell Blvd, Granite City, IL 62040 Phone: 618-709-4125 |