Healthcare Provider Details

I. General information

NPI: 1649598384
Provider Name (Legal Business Name): PROFESSIONAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 C. SWEETBRIAR DRIVE
CHILLICOTHEE IL
61523-2229
US

IV. Provider business mailing address

525 C. SWEETBRIAR DRIVE
CHILLICOTHEE IL
61523-2229
US

V. Phone/Fax

Practice location:
  • Phone: 309-274-6314
  • Fax: 309-274-4100
Mailing address:
  • Phone: 309-274-6314
  • Fax: 309-274-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL R RILEY
Title or Position: PRESIDENT
Credential:
Phone: 618-234-9705