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NPI Code Detail

MEDICARE: CARLY MICHELLE MACHACEK DPT

MEDICARE: CARLY MICHELLE MACHACEK DPT
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 Therapist
22251X0800XOrthopedic Physical Therapist11-06393KS
32251X0800XOrthopedic Physical Therapist2019031259MO

General Provider Information

NPI Number : 1700446721
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY MICHELLE MACHACEK DPT
Provider Business Mailing Address
First Line : 850 43RD AVE STE 100
Second Line :
City : MOLINE
State : IL
Zip : 61265-8401
Country : US
Telephone Number : 309-743-2070
Fax Number :
Provider Business Practice Location Address
First Line : 9901 N KNOXVILLE AVE STE D
Second Line :
City : PEORIA
State : IL
Zip : 61615-1433
Country : US
Telephone Number : 309-243-1989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2019
Last Update Date : 03/07/2023

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Directions to “ CARLY MICHELLE MACHACEK DPT” Practice Location

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