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NPI Code Detail

MEDICARE: BRANDON QUEEN DPT

MEDICARE: BRANDON QUEEN DPT
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 Therapist070016276IL

General Provider Information

NPI Number : 1710158035
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON QUEEN DPT
Provider Business Mailing Address
First Line : 1783 N RICHMOND RD
Second Line :
City : MCHENRY
State : IL
Zip : 60051-5413
Country : US
Telephone Number : 815-385-0730
Fax Number : 815-385-0572
Provider Business Practice Location Address
First Line : 1783 N RICHMOND RD
Second Line :
City : MCHENRY
State : IL
Zip : 60051-5413
Country : US
Telephone Number : 815-385-0730
Fax Number : 815-385-0572
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2008
Last Update Date : 05/24/2012

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Directions to “ BRANDON QUEEN DPT” Practice Location

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