Healthcare Provider Details

I. General information

NPI: 1568002384
Provider Name (Legal Business Name): MARIZ HUGHES BS PHYSICAL THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N CUMMINGS LN
WASHINGTON IL
61571-9267
US

IV. Provider business mailing address

325 CIRCLE DR
MORTON IL
61550-1320
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-2305
  • Fax:
Mailing address:
  • Phone: 309-648-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070017459
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: