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General NPI Number Information
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NPI Number | 1962202754
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Entity Type | Individual
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Provider Name | ELENA PATRICIA HALBACH
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 901 MEDICAL CENTER DR
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City | MONTICELLO
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State | IL
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Zip | 61856-2144
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Country | US
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Telephone | 217-210-0965
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 N NOTTINGHAM CT
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City | CHAMPAIGN
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State | IL
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Zip | 61821-7017
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Country | US
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Telephone |
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Fax |
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 07001002
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License Number State | IL
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