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NPI Code Detail

MEDICARE: MR. DOUGLAS SKIP FABRY LPTA

MEDICARE: MR. DOUGLAS SKIP FABRY LPTA
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
1225200000XPhysical Therapy Assistant160.003513IL

General Provider Information

NPI Number : 1720474794
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS SKIP FABRY LPTA
Provider Business Mailing Address
First Line : 202 W AGARD ST
Second Line :
City : WYOMING
State : IL
Zip : 61491-1324
Country : US
Telephone Number : 309-883-5733
Fax Number :
Provider Business Practice Location Address
First Line : 202 W AGARD ST
Second Line :
City : WYOMING
State : IL
Zip : 61491-1324
Country : US
Telephone Number : 309-883-5733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2015
Last Update Date : 04/07/2015

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