Student

NPI #1285992909 in Petersburg, Illinois

Provider Information

NPI Number: 1285992909
Entity Type: Organization
Organization Name: Student
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: May 1, 2012
Last Updated: May 1, 2012

Practice Location

Address: 16554 N MEADOW LN
City: Petersburg
State: Illinois
ZIP Code: 62675-6786
Phone: (217) 891-7941

Authorized Official

Name: NATHAN HOWARTH
Title: PHYSICAL THERAPY
Phone: (217) 891-7941

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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