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General NPI Number Information
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NPI Number | 1013717321
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Entity Type | Organization
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Legal Business Name | CORE WELLNESS PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 611 ARCHER AVE
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City | MARSHALL
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State | IL
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Zip | 62441-1267
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Country | US
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Telephone | 217-264-3277
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Fax |
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Provider Business Mailing Address
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Address Line | 16785 E NATIONAL RD
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City | MARSHALL
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State | IL
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Zip | 62441-4250
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Country | US
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Telephone | 217-264-3277
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. JORDAN BROWN
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Credential | PT, DPT
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Telephone | 217-264-3277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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