Provider Demographics
NPI:1700159241
Name:NEUMANN, RUSTY CARL (DPT)
Entity Type:Individual
Prefix:
First Name:RUSTY
Middle Name:CARL
Last Name:NEUMANN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E CARPENTER ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5165
Mailing Address - Country:US
Mailing Address - Phone:217-744-8000
Mailing Address - Fax:217-744-8004
Practice Address - Street 1:320 E CARPENTER ST STE 1B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5165
Practice Address - Country:US
Practice Address - Phone:217-744-8000
Practice Address - Fax:217-744-8004
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist