Healthcare Provider Details

I. General information

NPI: 1770313074
Provider Name (Legal Business Name): COLYN DAILEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N CUMMINGS LN
WASHINGTON IL
61571-9267
US

IV. Provider business mailing address

227 E GREENWOOD ST
TOULON IL
61483-8656
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: