Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070022500 | IL |
NPI | 1275089310 |
---|---|
Provider Name | Angela Mackowiak |
First Address | Glenview, IL 60025-4747 |
Second Address | Glenview, IL 60026-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 29/08/2016 |