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General NPI Number Information
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NPI Number | 1831758804
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Entity Type | Organization
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Legal Business Name | DIRECT PHYSIOHEALTH, LLC.
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 658 W SAWYER ST
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City | DECATUR
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State | IL
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Zip | 62526-4059
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Country | US
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Telephone | 312-219-5440
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Fax | 866-895-4081
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Provider Business Mailing Address
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Address Line | 658 W SAWYER ST
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City | DECATUR
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State | IL
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Zip | 62526-4059
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Country | US
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Telephone | 312-219-5440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA PALMER
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Credential | PT
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Telephone | 312-219-5440
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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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