Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | IL |
NPI | 1568834380 |
---|---|
Provider Name | Anthony Queen |
First Address | Lombard, IL 60148-7150 |
Second Address | Hines, IL 60141-3030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2015 |
Last Update Date | 21/10/2015 |