Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.009357 | IL |
NPI | 1013660216 |
---|---|
Provider Name | Abigail Wobbe |
First Address | Shiloh, IL 62269-2970 |
Second Address | Godfrey, IL 62035-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |