Healthcare Provider Details

I. General information

NPI: 1083132088
Provider Name (Legal Business Name): PROFESSIONAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 W VAN WINKLE WAY STE 3100
PEORIA IL
61615-7483
US

IV. Provider business mailing address

2810 FRANK SCOTT PKWY W STE 824
BELLEVILLE IL
62223-5007
US

V. Phone/Fax

Practice location:
  • Phone: 309-693-9189
  • Fax:
Mailing address:
  • Phone: 618-234-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023184
License Number StateIL

VIII. Authorized Official

Name: ANGIE JOELLENBECK
Title or Position: HR ASSISTANT
Credential:
Phone: 309-674-7874