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General NPI Number Information
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NPI Number | 1093205379
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Entity Type | Individual
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Provider Name | ROBYN MARIE NALL PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/13/2018
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Last Update Date | 05/13/2018
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Provider Practice Location Address
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Address Line | 1601 E MAIN ST UNIT G
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City | SAINT CHARLES
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State | IL
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Zip | 60174-2431
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Country | US
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Telephone | 847-732-5880
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Fax | 630-454-3555
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Provider Business Mailing Address
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Address Line | 39W308 BAERT LN
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City | SAINT CHARLES
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State | IL
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Zip | 60175-7735
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Country | US
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Telephone | 847-732-5880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 070014993
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License Number State | IL
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