MEDICARE: MYLEE DEANN VENTERS

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
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1134919160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLEE DEANN VENTERS

Provider Business Mailing Address
First Line	:	5255 E MARYLAND ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-9705
Country	:	US
Telephone Number	:	217-864-1264
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 E MARYLAND ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-9705
Country	:	US
Telephone Number	:	217-864-1264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ MYLEE DEANN VENTERS ” Practice Location

Language	Start Address	Practice Location

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