Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.008222 | IL |
NPI | 1003370461 |
---|---|
Provider Name | Brooke Hasier |
First Address | Monee, IL 60449-8980 |
Second Address | Bradley, IL 60915-1258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2019 |
Last Update Date | 29/01/2019 |