Individual
DIANNE HERGENROTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
611 W. PARK ST., URBANA, IL 61801-2500
(217) 383-3360
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6941
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070012499
IL
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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