Ida Riva Jamandron Caro, PT
Individual provider Active NPI Physical Therapist · Herrin, IL
NPI 1104092956 · NPPES record last updated May 1, 2008
Key facts
- NPI
- 1104092956
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070016280 (IL)
- Practice address
- 201 S 14TH St
Herrin, IL 62948-3631 - Phone
- (618) 942-2171
- Fax
- (618) 351-4926
- NPI assigned
- May 1, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070016280 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070016280 | IL | Yes |
Addresses
Primary practice location
201 S 14TH St
Herrin, IL 62948-3631
Mailing address
803 1/2 W Pecan St
Apt. C
Carbondale, IL 62901-1483
Phone (618) 201-9459
Other providers in Herrin, IL
- Ben J Calcaterra
- Camarato Drug Inc
- Stephanie Camarato
- Duaine Carlton
- Marcia Carlton
- Cortney Kristian Cash
- Rina Elizabeth Caslow
- Taylor Castellano
- Centercore Medical LLC
- Sylvia Ann Chalem
All providers in Herrin, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.