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General NPI Number Information
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NPI Number | 1669941555
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Entity Type | Individual
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Provider Name | COLLIN TOENNIES
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Gender | Male
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 251 MARKETPLACE DR # FREEBURG
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City | FREEBURG
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State | IL
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Zip | 62243-4082
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Country | US
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Telephone | 618-979-5348
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Fax |
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Provider Business Mailing Address
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Address Line | 19717 SAINT ROSE RD
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City | BREESE
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State | IL
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Zip | 62230-2207
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Country | US
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Telephone | 618-979-5348
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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 | 070.024096
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License Number State | IL
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