JENELLE DEATHERAGE

PEORIA, IL
NPI1720090830
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: IL  070020706)
Additional Taxonomies225100000X Physical Therapist
(Licence: MN  7357)
Enumeration Date2006-08-13
Last Update Date2014-06-26
Business Address
-- JENELLE DEATHERAGE PT
9901 N KNOXVILLE AVE STE D
PEORIA, IL 61615-1429
Phone number: 309-243-1989
Mailing Address
-- JENELLE DEATHERAGE PT
850 43RD AVE STE 100
MOLINE, IL 61265-8401
Phone number: 309-743-2070