Healthcare Provider Details

I. General information

NPI: 1770709115
Provider Name (Legal Business Name): WILLIAM FRANKLIN MCGEHEE JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NE MADISON AVE
PEORIA IL
61602-1109
US

IV. Provider business mailing address

306 CIRCUIT CT
EAST PEORIA IL
61611-1433
US

V. Phone/Fax

Practice location:
  • Phone: 309-674-7874
  • Fax:
Mailing address:
  • Phone: 309-694-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070009207
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: