Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL |
NPI | 1003084757 |
---|---|
Provider Name | Dina Petricca |
First Address | Mt Prospect, IL 60056-3135 |
Second Address | Mt Prospect, IL 60056-3135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 15/02/2008 |