Healthcare Provider Details

I. General information

NPI: 1003521998
Provider Name (Legal Business Name): ACROSS ALL AGES PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S GERMANTOWN RD
BREESE IL
62230-2088
US

IV. Provider business mailing address

380 S GERMANTOWN RD
BREESE IL
62230-2088
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-9311
  • Fax: 877-420-7862
Mailing address:
  • Phone: 618-526-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARGARET TIMMERMANN
Title or Position: OWNER
Credential: PT
Phone: 618-526-9311