Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 70015875 | IL |
N | 2251N0400X | Physical Therapist - Neurology | 70015875 | IL |
N | 2251P0200X | Physical Therapist - Pediatrics | 070015875 | |
N | 2251X0800X | Physical Therapist - Orthopedic | 7015875 | IL |
NPI | 1730371915 |
---|---|
Provider Name | Mallory Schug |
First Address | Woodstock, IL 60098-2265 |
Second Address | Woodstock, IL 60098-2265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 14/08/2008 |