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General NPI Number Information
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NPI Number | 1083769475
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPISTS CLINIC, LTD
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 1440 W WALNUT ST SUITE2
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1143
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Country | US
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Telephone | 217-245-1325
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Fax | 217-243-6903
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Provider Business Mailing Address
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Address Line | 1440 W WALNUT ST SUITE2
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1143
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Country | US
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Telephone | 217-245-1325
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Fax | 217-243-6903
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MRS. CHERYL DIANE BARBER
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Credential |
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Telephone | 217-245-1325
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203000094
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License Number State | IL
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