Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160000211 | IL |
NPI | 1003233768 |
---|---|
Provider Name | Kathleen Woodcock |
First Address | Pittsfield, IL 62363-1768 |
Second Address | Pittsfield, IL 62363-1768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2014 |
Last Update Date | 19/03/2014 |