Organization
AGE REHAB & MEDICAL FITNESS
Active
Other names
Age Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR ERUDE LIDAYWA DPT (OWNER / PHYSICAL THERAPIST)
(309) 833-1004
Entity
Organization
Contact information
Practice address
1701 W JACKSON ST STE C, MACOMB, IL 61455-3175
(309) 331-3590
Mailing address
1701 W JACKSON ST STE C, MACOMB, IL 61455-3175
(309) 331-3590
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/30/2019
Last updated
02/02/2022
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