Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.006368 | IL |
NPI | 1003302274 |
---|---|
Provider Name | Barbara Lynn Notz |
First Address | Springfield, IL 62702-1358 |
Second Address | Springfield, IL 62711-7917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |