Provider Demographics
NPI:1992219638
Name:ROUTH, DANIEL C (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:ROUTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FRANK SCOTT PKWY W STE 928
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5000
Mailing Address - Country:US
Mailing Address - Phone:618-234-9705
Mailing Address - Fax:618-234-9867
Practice Address - Street 1:525 S SWEETBRIAR DR STE C
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-2266
Practice Address - Country:US
Practice Address - Phone:309-274-6314
Practice Address - Fax:309-274-4100
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist