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NPI Code Detail

MEDICARE: CARLE SPORTS MEDICINE

MEDICARE: CARLE SPORTS MEDICINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283X00000XRehabilitation Hospital

General Provider Information

NPI Number : 1861440778
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARLE SPORTS MEDICINE
Provider Business Mailing Address
First Line : 2509 BRETT DRIVE
Second Line :
City : CHAMPAIGN
State : IL
Zip : 61821
Country : US
Telephone Number : 217-239-2936
Fax Number :
Provider Business Practice Location Address
First Line : 810 W ANTHONY DR
Second Line :
City : URBANA
State : IL
Zip : 61802-7431
Country : US
Telephone Number : 217-383-3300
Fax Number :
Authorized Official
Title or Position : ATHLETIC TRAINER CERTIFIED
Name : MRS. KARY RAE COLLETTE
Credential : ATC,LAT
Telephone Number : 217-239-2936
Provider Enumeration Date : 05/04/2006
Last Update Date : 08/22/2020

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Directions to “CARLE SPORTS MEDICINE ” Practice Location

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