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General NPI Number Information
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NPI Number | 1912241043
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Entity Type | Organization
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Legal Business Name | LAJOYE PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 905 CHICKASAW CT
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City | MASCOUTAH
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State | IL
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Zip | 62258-1637
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Country | US
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Telephone | 618-514-9610
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Fax | 618-448-0241
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Provider Business Mailing Address
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Address Line | 905 CHICKASAW CT
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City | MASCOUTAH
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State | IL
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Zip | 62258-1637
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Country | US
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Telephone | 618-514-9610
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Fax | 618-448-0241
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KIM LAJOYE
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Credential | MPT
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Telephone | 618-514-9610
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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 | IL
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