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General NPI Number Information
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NPI Number | 1558500124
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Entity Type | Organization
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Legal Business Name | MANTENO PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 19 W DIVISION ST
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City | MANTENO
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State | IL
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Zip | 60950-1533
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Country | US
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Telephone | 815-468-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 19 W DIVISION ST
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City | MANTENO
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State | IL
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Zip | 60950-1533
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Country | US
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Telephone | 815-468-7300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL A RYBA
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Credential | P.T.
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Telephone | 815-468-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 070.008529
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License Number State | IL
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