Healthcare Provider Details

I. General information

NPI: 1083738280
Provider Name (Legal Business Name): KNIGHT MEDICAL & REHAB CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N BRANDYWINE DR
PEORIA IL
61614-5550
US

IV. Provider business mailing address

4300 N BRANDYWINE DR
PEORIA IL
61614-5550
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-0123
  • Fax: 309-692-0184
Mailing address:
  • Phone: 309-692-0123
  • Fax: 309-692-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011932
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-017539
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. REBECCA KNIGHT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-692-0123