Bret Tibay Pelesco, PT, DPT
Individual provider Active NPI Physical Therapist · Marshall, IL
NPI 1780468009 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1780468009
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070027209 (IL)
- Practice address
- 410 N 2ND St
Marshall, IL 62441-1010 - Phone
- (217) 826-2358
- NPI assigned
- Aug 21, 2023
- Sex
- Male
- 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 |
|---|---|---|---|
| 070027209 | IL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070027209 | IL | Yes |
Addresses
Primary practice location
410 N 2ND St
Marshall, IL 62441-1010
Mailing address
102 Brosman LN Apt 2
Marshall, IL 62441-1096
Other providers in Marshall, IL
- Isabelle Lee Maurer
- Marlene McDonald-Smithson
- Michaela Marie Miller
- Holly Newkirk
- Marilyn Sue Patton
- Denise Pine-Mattas
- Gayle Rayhel
- Restoration Dental LLC- Marshall Dental Professionals
- Rhoads to Healthy LLC
- Selah Partners, LLC
All providers in Marshall, 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 Aug 21, 2023. 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.