Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | IL |
NPI | 1710364468 |
---|---|
Provider Name | Denise Van Vossen |
First Address | Chicago, IL 60622 |
Second Address | Hines, IL 60141-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2015 |
Last Update Date | 01/05/2015 |