Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070007792 | IL |
NPI | 1174984405 |
---|---|
Provider Name | Allison Johnson |
First Address | Crystal Lake, IL 60014-3434 |
Second Address | Crystal Lake, IL 60014-3434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2016 |
Last Update Date | 15/03/2016 |