Active NPI
Michelle Marie Tink, DPT
- Physical Therapist
- Maryville, IL
National Provider Identifier
1801564562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.024644
- Practice address
- 6960 Il-162
Maryville, IL 62062 - Phone
- (618) 288-2211
- NPI assigned
- Aug 30, 2021
- Last updated
- Aug 30, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.024644 | IL | Primary |
Addresses
Primary practice location
6960 Il-162
Maryville, IL 62062
Mailing address
620 8TH St
Highland, IL 62249-1509
Phone (319) 504-3945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.024644 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630281600000",
"number": "1801564562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 8TH ST",
"city": "HIGHLAND",
"state": "IL",
"postal_code": "622491509",
"telephone_number": "319-504-3945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6960 IL-162",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "62062",
"telephone_number": "618-288-2211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TINK",
"first_name": "MICHELLE",
"middle_name": "MARIE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-30",
"last_updated": "2021-08-30",
"certification_date": "2021-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.024644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maryville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.