Healthcare Provider Details

I. General information

NPI: 1891171047
Provider Name (Legal Business Name): ROCK VALLEY PHYSICAL THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 N KNOXVILLE AVE STE D
PEORIA IL
61615-1433
US

IV. Provider business mailing address

850 43RD AVE STE. 100
MOLINE IL
61265-8401
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-1989
  • Fax: 309-243-8138
Mailing address:
  • Phone: 309-743-2070
  • Fax: 309-743-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: RANDALL E BOLDT
Title or Position: PT, CFO
Credential: PT
Phone: 309-743-2070