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General NPI Number Information
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NPI Number | 1821553702
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Entity Type | Organization
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Legal Business Name | IN-HOME PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 7324 N UNIVERSITY ST
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City | PEORIA
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State | IL
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Zip | 61614-1230
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Country | US
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Telephone | 217-821-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 501 TREFOIL
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City | SAVOY
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State | IL
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Zip | 61874-8511
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Country | US
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Telephone | 217-419-3747
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KISHORILAL THOPE
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Credential | PT
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Telephone | 217-419-3747
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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 |
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License Number State |
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