Healthcare Provider Details

I. General information

NPI: 1336773696
Provider Name (Legal Business Name): ILLINOIS THERAPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WELLNESS OFFICE 941 6TH STREET
MOLINE IL
61265-1101
US

IV. Provider business mailing address

217 E BREMER AVE
WAVERLY IA
50677-3435
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-4544
  • Fax: 319-352-4655
Mailing address:
  • Phone: 319-231-9446
  • Fax: 319-352-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL JOHN BRITT
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential: DC
Phone: 319-352-2726