Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160005554 | IL |
NPI | 1013288075 |
---|---|
Provider Name | Jamal Sharif Hassan |
First Address | Chicago, IL 60643-4004 |
Second Address | Chicago, IL 60643-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |