Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 4183 | NE |
NPI | 1255985271 |
---|---|
Provider Name | Katie Ilardi |
First Address | Omaha, NE 68130-1035 |
Second Address | Omaha, NE 68130-1035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 13/07/2021 |