Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.001468 | IL |
NPI | 1003351230 |
---|---|
Provider Name | Marguerite Simmons |
First Address | Forest Park, IL 60130-3316 |
Second Address | Forest Park, IL 60130-3316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2016 |
Last Update Date | 26/12/2016 |