Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | IL | |
Y | 225100000X | Physical Therapist | 070018096 | IL |
NPI | 1003121427 |
---|---|
Provider Name | Emily R Rynne |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Alsip, IL 60803-2313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 17/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00915454 | MEDICARE RAILROAD (01) | IL |