MEDICARE: ADAM ARTHUR HANES MPT

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	070.013338	IL

General Provider Information

NPI Number	:	1194063826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM ARTHUR HANES MPT

Provider Business Mailing Address
First Line	:	486 N MAIN ST
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-1828
Country	:	US
Telephone Number	:	309-357-5470
Fax Number	:	309-357-5943

Provider Business Practice Location Address
First Line	:	486 N MAIN ST
Second Line	:
City	:	CANTON
State	:	IL
Zip	:	61520-1828
Country	:	US
Telephone Number	:	309-357-5470
Fax Number	:	309-357-5943

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

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	04/14/2015

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