Individual
MR. CID ANTHONY MELOCOTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2625 KIPLING DR, SPRINGFIELD, IL 62711-6232
(217) 899-1658
Mailing address
2625 KIPLING DR, SPRINGFIELD, IL 62711-6232
(217) 899-1658
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070008391
IL
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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