Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160004548 | IL |
NPI | 1023151024 |
---|---|
Provider Name | Linda Marie Elliott |
First Address | Peoria, IL 61614-3294 |
Second Address | Peoria, IL 61614-3294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 31/12/2019 |