MYOFASCIAL RELEASE OF SOUTHERN ILLINOIS NPI 1851722946

NPI Information

NPI: 1851722946
Provider Name: MYOFASCIAL RELEASE OF SOUTHERN ILLINOIS
Classification: Clinic/Center - 261QR0400X
Entity Type: Organization

Specialization: Rehabilitation

Address:
101 S GRAHAM AVE
SUITE 3
CARBONDALE, IL
ZIP 62901
Phone: (618) 305-4696
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MYOFASCIAL RELEASE OF SOUTHERN ILLINOIS is a rehabilitation clinic center in Carbondale, IL. MYOFASCIAL RELEASE OF SOUTHERN ILLINOIS NPI is 1851722946. The provider is registered as an organization entity type.

The provider's business location address is:

101 S GRAHAM AVE
SUITE 3
CARBONDALE, IL
ZIP 62901-043
Phone: (618) 305-4696
Fax: (888) 975-0097

The provider's authorized official is Tara Manzano .
The authorized official title is President/occupational Therapist and has the following contact phone number (618) 305-4696.

The enumeration date for this NPI number is 11/27/2013 and was last updated on 11/4/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0400X	Clinic/Center	Rehabilitation	248.000873	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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