Healthcare Provider Details

I. General information

NPI: 1255478335
Provider Name (Legal Business Name): CENTRAL ILLINOIS INSTITUTE OF BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 LANDMARK DRIVE STE E3
NORMAL IL
61761
US

IV. Provider business mailing address

211 LANDMARK DR STE E3
NORMAL IL
61761-6165
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-4900
  • Fax: 309-663-4197
Mailing address:
  • Phone: 309-663-4900
  • Fax: 309-663-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-007930
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-000121
License Number StateIL

VIII. Authorized Official

Name: POONAM MCALLISTER
Title or Position: PT/OWNER
Credential: PT
Phone: 309-663-4900