Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.003981 | IL |
NPI | 1013474402 |
---|---|
Provider Name | Kristin Upp |
First Address | Plainfield, IL 60586-6633 |
Second Address | Joliet, IL 60435-8200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |