Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070015548 | IL |
NPI | 1003168063 |
---|---|
Provider Name | Alicia Andry |
First Address | Chicago, IL 60605-1853 |
Second Address | Chicago, IL 60605-1853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2012 |
Last Update Date | 02/12/2020 |