Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL | |
N | 2251X0800X | Physical Therapist - Orthopedic | 070020671 | IL |
NPI | 1013335637 |
---|---|
Provider Name | Kelly Thomsen |
First Address | Chicago, IL 60614-2129 |
Second Address | Chicago, IL 60614-2129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 18/05/2020 |