Healthcare Provider Details

I. General information

NPI: 1245092410
Provider Name (Legal Business Name): HAYLIE NICOLE LADING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DR
MATTOON IL
61938-4644
US

IV. Provider business mailing address

15471 MORGAN LN
HUMBOLDT IL
61931-7906
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2525
  • Fax:
Mailing address:
  • Phone: 217-259-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.027366
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: