Healthcare Provider Details

I. General information

NPI: 1174667166
Provider Name (Legal Business Name): ERIN D HUEBNER P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 FRANK SCOTT PKWY W SUITE 824
BELLEVILLE IL
62223-5007
US

IV. Provider business mailing address

211 E HANOVER ST
NEW BADEN IL
62265-1811
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-9705
  • Fax: 618-257-0665
Mailing address:
  • Phone: 618-588-4000
  • Fax: 618-588-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: