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General NPI Number Information
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NPI Number | 1558480418
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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 | 03/29/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 1440 W WALNUT ST SUITE 2
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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 | 217-245-1455
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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 SUITE 2
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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 | 217-245-1455
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Fax | 217-243-6903
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Authorized Official
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Title or Position | INSURANCE ADMINISTRATOR
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Name | CHERYL DIANE BARBER
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Credential |
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Telephone | 217-245-1455
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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 |
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License Number State |
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