Healthcare Provider Details

I. General information

NPI: 1437855210
Provider Name (Legal Business Name): ST ANTHONYS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 30TH ST STE 2
ROCK ISLAND IL
61201-1945
US

IV. Provider business mailing address

767 30TH ST STE 2
ROCK ISLAND IL
61201-1945
US

V. Phone/Fax

Practice location:
  • Phone: 309-292-5499
  • Fax:
Mailing address:
  • Phone: 309-292-5499
  • Fax:

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: RAJIV SHAH
Title or Position: CEO
Credential:
Phone: 561-315-5037