Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070-010391 | IL |
NPI | 1083182596 |
---|---|
Provider Name | Doris A Thole |
First Address | Glenview, IL 60026-8001 |
Second Address | Belleville, IL 62220-1055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2018 |
Last Update Date | 02/11/2018 |