Individual
CARLY MICHELLE MACHACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9901 N KNOXVILLE AVE STE D, PEORIA, IL 61615-1433
(309) 243-1989
Mailing address
850 43RD AVE STE 100, MOLINE, IL 61265-8401
(309) 743-2070
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
11-06393
KS
2251X0800X
Orthopedic Physical Therapist
Primary
2019031259
MO
Other
Enumeration date
06/20/2019
Last updated
03/07/2023
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