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General NPI Number Information
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NPI Number | 1700279130
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Entity Type | Organization
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Legal Business Name | HANES PHYSICAL THERAPY, LTD.
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 486 N MAIN ST
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City | CANTON
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State | IL
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Zip | 61520-1828
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Country | US
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Telephone | 309-339-1808
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Fax |
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Provider Business Mailing Address
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Address Line | 486 N MAIN ST
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City | CANTON
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State | IL
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Zip | 61520-1828
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Country | US
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Telephone | 309-339-1808
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | MR. ADAM A. HANES
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Credential | M.P.T.
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Telephone | 309-339-1808
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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 | 070.013338
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License Number State | IL
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