Provider Demographics
NPI:1225856479
Name:PATHWAY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PATHWAY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-541-7944
Mailing Address - Street 1:72 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GERMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61039-9012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6870
Practice Address - Country:US
Practice Address - Phone:815-235-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty