Provider Demographics
NPI:1215201322
Name:STRICKER, MICHAEL BRANTLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRANTLEY
Last Name:STRICKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1544
Mailing Address - Country:US
Mailing Address - Phone:618-658-8144
Mailing Address - Fax:618-658-9146
Practice Address - Street 1:811 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1544
Practice Address - Country:US
Practice Address - Phone:618-658-8144
Practice Address - Fax:618-658-9146
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist