Provider Demographics
NPI:1255003158
Name:ADAPTIVE EQUIPMENT CORNER, LLC
Entity Type:Organization
Organization Name:ADAPTIVE EQUIPMENT CORNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN-WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:618-206-8401
Mailing Address - Street 1:252 PEORIA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3583
Mailing Address - Country:US
Mailing Address - Phone:618-206-8401
Mailing Address - Fax:618-227-0097
Practice Address - Street 1:252 PEORIA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3583
Practice Address - Country:US
Practice Address - Phone:618-206-8401
Practice Address - Fax:618-227-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy