Provider Demographics
NPI:1669941555
Name:TOENNIES, COLLIN
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:TOENNIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19717 SAINT ROSE RD
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-2207
Mailing Address - Country:US
Mailing Address - Phone:618-979-5348
Mailing Address - Fax:
Practice Address - Street 1:251 MARKETPLACE DR # FREEBURG
Practice Address - Street 2:
Practice Address - City:FREEBURG
Practice Address - State:IL
Practice Address - Zip Code:62243-4082
Practice Address - Country:US
Practice Address - Phone:618-979-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.024096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist