Provider Demographics
NPI:1437778412
Name:MACFARLANE, ROBERT FRANCIS III (ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANCIS
Last Name:MACFARLANE
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1366
Mailing Address - Country:US
Mailing Address - Phone:217-778-0395
Mailing Address - Fax:
Practice Address - Street 1:3105 PALMER DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1366
Practice Address - Country:US
Practice Address - Phone:217-778-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960047572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer