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General NPI Number Information
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NPI Number | 1558842658
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Entity Type | Individual
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Provider Name | RONAKSINGH THAKUR PT
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Gender | Male
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 210 E COLLEGE ST
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City | ENERGY
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State | IL
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Zip | 62933-3568
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Country | US
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Telephone | 618-942-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 CROWN RD
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City | HERRIN
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State | IL
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Zip | 62948-6526
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Country | US
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Telephone | 618-967-8741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 070022068
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License Number State | IL
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