Organization
FAMILY PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT STANLEY JOHANNSEN PT (PHYSICAL THERAPIST/OWNER)
(309) 523-2949
Entity
Organization
Contact information
Practice address
103 N MAIN ST, PORT BYRON, IL 61275-7705
(309) 523-2949
Mailing address
P.O. BOX 125, 103 NORTH MAIN STREET, PORT BYRON, IL 61275-7703
(309) 523-2949
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070006904
IL
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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