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NPI Code Detail

MEDICARE: LISENBY PHYSICAL THERAPY FOR WOMEN, INC.

MEDICARE: LISENBY PHYSICAL THERAPY FOR WOMEN, INC.
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
1261QP2000XPhysical Therapy Clinic/Center070013673IL

General Provider Information

NPI Number : 1841638228
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISENBY PHYSICAL THERAPY FOR WOMEN, INC.
Provider Business Mailing Address
First Line : 5101 N EXECUTIVE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-4868
Country : US
Telephone Number : 309-839-8631
Fax Number : 855-579-3536
Provider Business Practice Location Address
First Line : 5101 N EXECUTIVE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-4868
Country : US
Telephone Number : 309-839-8631
Fax Number : 855-579-3536
Authorized Official
Title or Position : PRESIDENT
Name : MOLLY LISENBY
Credential : PT
Telephone Number : 309-839-8631
Provider Enumeration Date : 06/07/2013
Last Update Date : 03/26/2024

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