Provider Demographics
NPI:1740465954
Name:DOOLEY, TONYA JO (PT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:JO
Last Name:DOOLEY
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 1:552 N STATE HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:SUTTER
Mailing Address - State:IL
Mailing Address - Zip Code:62373-5029
Mailing Address - Country:US
Mailing Address - Phone:309-221-2041
Mailing Address - Fax:
Practice Address - Street 1:4531 MAINE ST STE C
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5877
Practice Address - Country:US
Practice Address - Phone:217-228-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.006554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist