IndividualActive
Grace Punke, PTA
NPI 1366317430 · Physical Therapy Assistant · Canton, IL
Provider details
- NPI number
- 1366317430
- Entity type
- Individual
- Primary specialty
- Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- PTA
- Sex
- Female
- Sole proprietor
- Yes
- License
- 160.010243 (IL)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
180 S Main St
Canton, IL 61520-2608
Phone: (309) 647-5240
Approximate (ZIP-level) locationGet directions
Mailing address
1505 N Autumn Ln
Peoria, IL 61604-4601
Registry dates
- Enumerated
- 2025-10-08
- Last updated
- 2025-10-08
- Certified
- 2025-10-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.