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General NPI Number Information
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NPI Number | 1306014196
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Entity Type | Organization
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Legal Business Name | LIFEFIT PHYSICAL REHAB, LTD.
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 1225 N. SIXTH ST.
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City | PRINCETON
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State | IL
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Zip | 61356
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Country | US
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Telephone | 815-875-2348
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Fax | 815-875-2334
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Provider Business Mailing Address
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Address Line | 1225 N. SIXTH ST.
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City | PRINCETON
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State | IL
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Zip | 61356
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Country | US
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Telephone | 815-875-2348
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Fax | 815-875-2334
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. BARBARA A. PETERSON
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Credential | PT
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Telephone | 815-875-2348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070005259
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License Number State | IL
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