Provider Demographics
NPI:1336773696
Name:ILLINOIS THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ILLINOIS THERAPY ASSOCIATES LLC
Other - Org Name:NIT OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-352-2726
Mailing Address - Street 1:217 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3435
Mailing Address - Country:US
Mailing Address - Phone:319-231-9446
Mailing Address - Fax:319-352-4655
Practice Address - Street 1:WELLNESS OFFICE
Practice Address - Street 2:941 6TH STREET
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1101
Practice Address - Country:US
Practice Address - Phone:319-352-4544
Practice Address - Fax:319-352-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty