Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL | |
N | 2251P0200X | Physical Therapist - Pediatrics | IL |
NPI | 1023204484 |
---|---|
Provider Name | Kristin Ann Lowe |
First Address | Maryville, IL 62062-8500 |
Second Address | Maryville, IL 62062-8500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 19/09/2007 |