Organization Name: | GATEWAY REHABILITATION TAYLORVILLE LLC |
NPI Number: | 1306946777 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY D HAWKINS (PARTNER) |
Mailing Address: | 301-305 S Webster Taylorville |
State: | IL US |
Postal Code: | 62568 |
Phone Number: | 6182589093 |
Fax Number: | 6182589097 |
NPI Enumeration Date: | 09/25/2006 |
NPI Last Update Date: | 04/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |