NPIMap

Organization Active NPI

Midwest Children's Therapy, PLLC

  • Physical Therapist
  • East Peoria, IL
National Provider Identifier
1881466738
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MIDWEST CHILDREN'S THERAPY, PLLC
Practice address
110 Carver LN
East Peoria, IL 61611-3052
Phone
(716) 308-9301
NPI assigned
Oct 24, 2023
Last updated
Oct 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tatum Nichols, PT, DPTNPI 1295186310
Title
Ceo
Phone
(716) 308-9301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

110 Carver LN
East Peoria, IL 61611-3052

Mailing address

110 Carver LN
East Peoria, IL 61611-3052
Phone (716) 308-9301

National Provider Directory

National Provider Directory

Locations

110 Carver Ln
East Peoria, IL 61611
Phone (309) 282-6704

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1881466738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 CARVER LN",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616113052",
            "telephone_number": "716-308-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 CARVER LN",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616113052",
            "telephone_number": "716-308-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST CHILDREN'S THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "TATUM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "716-308-9301",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.