Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070020609 | IL |
NPI | 1003234170 |
---|---|
Provider Name | Kathryn Julia Siegel |
First Address | Chicago, IL 60657-4368 |
Second Address | Chicago, IL 60614-1848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2014 |
Last Update Date | 19/07/2017 |