Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160002363 | IL |
NPI | 1013686195 |
---|---|
Provider Name | Kimberly Ann Harter |
First Address | Pittsfield, IL 62363-2602 |
Second Address | Pittsfield, IL 62363-9586 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2021 |
Last Update Date | 10/09/2021 |