Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070007958 | IL |
NPI | 1265672521 |
---|---|
Provider Name | Jennifer Beard |
First Address | Belvidere, IL 61008-2036 |
Second Address | Rockford, IL 61107-6222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 26/02/2009 |