Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070.013659 | IL |
NPI | 1114255221 |
---|---|
Provider Name | Maria Cherryl Floresca |
First Address | Montgomery, IL 60538-4051 |
Second Address | Montgomery, IL 60538-4051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2009 |
Last Update Date | 24/01/2012 |