MEDICARE: DIANA AGNEY

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	160.002238	IL

General Provider Information

NPI Number	:	1467841940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA AGNEY

Provider Business Mailing Address
First Line	:	2189 E 1525 NORTH RD
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-4536
Country	:	US
Telephone Number	:	217-774-3677
Fax Number	:

Provider Business Practice Location Address
First Line	:	2189 E 1525 NORTH RD
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-4536
Country	:	US
Telephone Number	:	217-774-3677
Fax Number	:

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

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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Directions to “ DIANA AGNEY ” Practice Location

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