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General NPI Number Information
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NPI Number | 1982781316
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Entity Type | Organization
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Legal Business Name | WAUCONDA PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 363 N MAIN ST SUITE A
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City | WAUCONDA
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State | IL
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Zip | 60084-3036
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Country | US
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Telephone | 847-487-0290
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Fax | 847-487-0492
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Provider Business Mailing Address
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Address Line | 363 N MAIN ST SUITE A
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City | WAUCONDA
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State | IL
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Zip | 60084-3036
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Country | US
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Telephone | 847-487-0290
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Fax | 847-487-0492
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SHARLENE D MECCHI
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Credential |
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Telephone | 847-487-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | IL
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