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General NPI Number Information
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NPI Number | 1841522935
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Entity Type | Individual
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Provider Name | TRISHA MIDDLETON DPT, CMPT
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Gender | Female
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Dates
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Enumeration Date | 02/01/2010
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 1138 VAUGHN RD
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City | WOOD RIVER
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State | IL
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Zip | 62095-1848
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Country | US
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Telephone | 618-259-1100
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Fax | 618-259-1101
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Provider Business Mailing Address
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Address Line | 1138 VAUGHN RD
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City | WOOD RIVER
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State | IL
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Zip | 62095-1848
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Country | US
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Telephone | 618-259-1100
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Fax | 618-259-1101
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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 | 2010001725
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070018162
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License Number State | IL
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