Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | IL | |
N | 2251P0200X | Physical Therapist - Pediatrics | IL |
NPI | 1083832265 |
---|---|
Provider Name | Joanne Effie Triantafillou |
First Address | Mokena, IL 60448-9274 |
Second Address | Mokena, IL 60448-9274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |