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NPI Code Detail

MEDICARE: PROFESSIONAL PHYSICAL THERAPY, PC

MEDICARE: PROFESSIONAL PHYSICAL THERAPY, PC
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
1225100000XPhysical Therapist060-007809IL

General Provider Information

NPI Number : 1083611008
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL PHYSICAL THERAPY, PC
Provider Business Mailing Address
First Line : 3815 N VERMILION ST
Second Line :
City : DANVILLE
State : IL
Zip : 61832-1159
Country : US
Telephone Number : 217-446-7878
Fax Number : 217-446-7865
Provider Business Practice Location Address
First Line : 3815 N VERMILION ST
Second Line :
City : DANVILLE
State : IL
Zip : 61832-1159
Country : US
Telephone Number : 217-446-7878
Fax Number : 217-446-7865
Authorized Official
Title or Position : PT/ OWNER
Name : RONNIE L DAY
Credential : PT
Telephone Number : 217-446-7878
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/13/2010

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Directions to “PROFESSIONAL PHYSICAL THERAPY, PC ” Practice Location

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