Organization
BEARDSTOWN THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA SORRELLS PT, DPT, ATC (OWNER)
(217) 248-5795
Entity
Organization
Contact information
Practice address
400 E 4TH ST, BEARDSTOWN, IL 62618-1307
(217) 248-5795
Mailing address
21 NORTH DR, BEARDSTOWN, IL 62618-4400
(217) 248-5795
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
2255A2300X
Athletic Trainer
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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