Healthcare Provider Details

I. General information

NPI: 1730138322
Provider Name (Legal Business Name): HANDS ON HEALTH PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11447 2ND ST STE 9B
ROSCOE IL
61073-9522
US

IV. Provider business mailing address

11447 2ND ST STE 9B
ROSCOE IL
61073-9522
US

V. Phone/Fax

Practice location:
  • Phone: 815-623-1476
  • Fax: 815-623-1476
Mailing address:
  • Phone: 815-623-1476
  • Fax: 815-623-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070005636
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA LEA LILJA
Title or Position: PRESIDENT/OWNER
Credential: PT
Phone: 815-623-1476