Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | 070024720 | IL |
NPI | 1083262547 |
---|---|
Provider Name | Brittany Pham |
First Address | Chicago, IL 60642-7028 |
Second Address | Chicago, IL 60611-2912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 12/09/2019 |