Healthcare Provider Details

I. General information

NPI: 1740605401
Provider Name (Legal Business Name): MORGAN MARIE YOUNT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MORGAN MARIE RUDOLPH

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAPLE ST
EFFINGHAM IL
62401-2006
US

IV. Provider business mailing address

12217 N 17TH AVE
IRVING IL
62051-2018
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-1243
  • Fax: 217-347-1558
Mailing address:
  • Phone: 217-556-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.020530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: