Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 160.006116 | IL |
NPI | 1093102352 |
---|---|
Provider Name | Jay Anthony Beco |
First Address | Orland Park, IL 60467-5602 |
Second Address | Orland Park, IL 60467-5602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 23/04/2015 |