Healthcare Provider Details

I. General information

NPI: 1154225696
Provider Name (Legal Business Name): LYDIA RHINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W NORTH 12TH ST
SHELBYVILLE IL
62565-9554
US

IV. Provider business mailing address

215 ILLINOIS AVE
MATTOON IL
61938-5845
US

V. Phone/Fax

Practice location:
  • Phone: 217-774-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160008990
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: