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NPI Code Detail

MEDICARE: DORIS A THOLE PT

MEDICARE: DORIS A THOLE PT
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
12251G0304XGeriatric Physical Therapist070-010391IL

General Provider Information

NPI Number : 1083182596
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIS A THOLE PT
Provider Business Mailing Address
First Line : 2600 COMPASS RD
Second Line :
City : GLENVIEW
State : IL
Zip : 60026-8001
Country : US
Telephone Number : 618-401-0671
Fax Number :
Provider Business Practice Location Address
First Line : 1021 W E ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1055
Country : US
Telephone Number : 618-233-2095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 11/02/2018

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Directions to “ DORIS A THOLE PT” Practice Location

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