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General NPI Number Information
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NPI Number | 1497295026
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Entity Type | Organization
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Legal Business Name | ANAM HEALING ARTS, LLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 4 EXECUTIVE WOODS CT
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City | SWANSEA
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State | IL
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Zip | 62226-2016
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Country | US
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Telephone | 618-444-2846
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Fax | 618-239-6444
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Provider Business Mailing Address
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Address Line | 4 EXECUTIVE WOODS CT
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City | SWANSEA
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State | IL
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Zip | 62226-2016
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Country | US
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Telephone | 618-444-2846
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Fax | 618-239-6444
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Authorized Official
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Title or Position | SOLE PRACTITIONER
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Name | LYRI MERRILL
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Credential | MSPT
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Telephone | 618-444-2846
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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 | 070016066
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License Number State | IL
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