MEDICARE: VINCENT MCQUIRTER 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
1	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1154460954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT MCQUIRTER PT

Provider Business Mailing Address
First Line	:	2108 N BIGELOW ST
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-3508
Country	:	US
Telephone Number	:	309-661-3375
Fax Number	:	309-664-0385

Provider Business Practice Location Address
First Line	:	135 N WILLIAMSBURG DR
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-3528
Country	:	US
Telephone Number	:	309-664-9104
Fax Number	:	309-664-2913

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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Directions to “ VINCENT MCQUIRTER PT” Practice Location

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