Healthcare Provider Details

I. General information

NPI: 1619981081
Provider Name (Legal Business Name): WILLIAM O WORTHINGTON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N SECOND STREET
MARSHALL IL
62441
US

IV. Provider business mailing address

PO BOX 40
MARSHALL IL
62441
US

V. Phone/Fax

Practice location:
  • Phone: 217-826-2365
  • Fax: 217-826-8120
Mailing address:
  • Phone: 217-826-2365
  • Fax: 217-826-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010429
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005753A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: