Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070013818 | IL |
NPI | 1063604759 |
---|---|
Provider Name | Lisette Brill |
First Address | Orland Park, IL 60467-5602 |
Second Address | Orland Park, IL 60467-5602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 18/05/2015 |