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NPI Code Detail

MEDICARE: SPRING EVANS MPT

MEDICARE: SPRING EVANS MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070018634IL

General Provider Information

NPI Number : 1073897161
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPRING EVANS MPT
Provider Business Mailing Address
First Line : PO BOX 362
Second Line :
City : SPRING GROVE
State : IL
Zip : 60081-0362
Country : US
Telephone Number : 815-675-0699
Fax Number : 815-675-0689
Provider Business Practice Location Address
First Line : 2900 N US HIGHWAY 12
Second Line : SUITE J
City : SPRING GROVE
State : IL
Zip : 60081-8322
Country : US
Telephone Number : 815-675-0699
Fax Number : 815-675-0689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2011
Last Update Date : 10/06/2011

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Directions to “ SPRING EVANS MPT” Practice Location

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