Provider Demographics
NPI:1922194604
Name:WEBB, NANCY KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KAY
Last Name:WEBB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 SOUTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939
Mailing Address - Country:US
Mailing Address - Phone:618-995-1169
Mailing Address - Fax:
Practice Address - Street 1:515 E VIENNA STREET
Practice Address - Street 2:SUITE I
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906
Practice Address - Country:US
Practice Address - Phone:618-833-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist