Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.003966 | IL |
NPI | 1013355874 |
---|---|
Provider Name | Diane Riess |
First Address | Algonquin, IL 60102-9623 |
Second Address | Algonquin, IL 60102-9623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2013 |
Last Update Date | 13/06/2013 |