Jenelle Deatherage in Moline - Physical Therapist
Jenelle Deatherage - NPI 1720090830
Jenelle Deatherage is a Physical Therapist in Moline, Illinois. Jenelle Deatherage practices all healthcare services and medical treatments related to Physical Therapist. The NPI Number for Jenelle Deatherage is 1720090830. The last update date is 2014-06-26.
Jenelle Deatherage's current location address is 850 43rd Ave Ste 100, Moline, Illinois. You can contact this provider via phone number 3097432070 and fax number 3097432073. The mailing address for Jenelle Deatherage is 850 43rd Ave Ste 100, Moline, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jenelle Deatherage |
|---|---|
| Address | 850 43rd Ave Ste 100, Moline, Illinois |
| Phone Number | 3097432070 |
| Fax Number | 3097432073 |
| Sole Proprietor | N |
| Credentials | PT |
NPI Number Detail
| NPI Number | 1720090830 |
|---|---|
| Provider Enumeration Date | 2006-08-13 |
| Last Updated Date | 2014-06-26 |
Provider Mailing Address Detail
| Address | 850 43rd Ave Ste 100 |
|---|---|
| City | Moline |
| State | Illinois (IL) |
| Post Code | 612658401 |
| Phone Number | 3097432070 |
| Fax Number | 3097432073 |
Provider's Primary Taxonomy Detail
| Speciality | Physical Therapist |
|---|---|
| Taxonomy | 225100000X |
| Licence No | 7357 |
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Definition: Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and per |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 70020706 | IL | ILLINOIS PT LICENSE NO. |
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What is the Jenelle Deatherage's unique identification number?
The Jenelle Deatherage has been assigned the NPI (National Provider Identifier) Number 1720090830 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Can you provide the Jenelle Deatherage's physical address?
The Jenelle Deatherage is physically located at 850 43Rd Ave Ste 100, in the city of Moline, IL, with the postal code 612658401.
What is the Jenelle Deatherage's area of specialization and corresponding taxonomy classification?
The Jenelle Deatherage's specialty field is Physical Therapist, and it falls under the taxonomy code 225100000X, which categorizes healthcare providers based on their specialties.
On what date did the Jenelle Deatherage receive the assignment of its 1720090830 from the Centers for Medicare & Medicaid Services?
The Jenelle Deatherage was issued its 1720090830 by the Centers for Medicare & Medicaid Services on 2006-08-13.
When was the information related to Jenelle Deatherage most recently updated or refreshed?
The details pertaining to the Jenelle Deatherage, including its address, specialty, and other relevant information, were last updated or refreshed on 2014-06-26.