Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 070.018912 | IL |
NPI | 1386868701 |
---|---|
Provider Name | Eryn Kubinski |
First Address | Joliet, IL 60435-6570 |
Second Address | Joliet, IL 60435-6570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070.018912 | PT LICENSE (01) | IL |