# FAMILY PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174959340
- **Authorized official:** MR. ROBERT STANLEY JOHANNSEN PT (PHYSICAL THERAPIST/OWNER)
- **Authorized official phone:** (309) 523-2949

## Contact information

- **Practice address:** 103 N MAIN ST, PORT BYRON, IL 61275-7705
- **Practice address phone:** (309) 523-2949
- **Mailing address:** P.O. BOX 125, 103 NORTH MAIN STREET, PORT BYRON, IL 61275-7703
- **Mailing address phone:** (309) 523-2949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 070006904 | IL | Yes |

## Other

- **Enumeration date:** 09/19/2013
- **Last updated:** 09/19/2013