Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1043883135 |
---|---|
Provider Name | Allison Marie Sivak |
First Address | Brookfield, IL 60513-2597 |
Second Address | Homer Glen, IL 60491-7847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |