Healthcare Provider Details

I. General information

NPI: 1093775561
Provider Name (Legal Business Name): MEMORIAL INDUSTRIAL REHABILITATION OF JACKSONVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MORTON AVE SUITE 16A
JACKSONVILLE IL
62650-3146
US

IV. Provider business mailing address

901 W MORTON AVE SUITE 16A
JACKSONVILLE IL
62650-3146
US

V. Phone/Fax

Practice location:
  • Phone: 217-245-4640
  • Fax: 217-245-4642
Mailing address:
  • Phone: 217-245-4640
  • Fax: 217-245-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: ROBERT T CLARKE
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 217-788-3340