=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154225696
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYDIA RHINE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 W NORTH 12TH ST
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62565-9554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-774-2111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 ILLINOIS AVE
-----------------------------------------------------
City | MATTOON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61938-5845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 160008990
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------