Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003306291 |
---|---|
Provider Name | Kelsey Lauren Makoul |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Jenkintown, PA 19046-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 14/05/2018 |