Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070006676 | IL |
NPI | 1598370231 |
---|---|
Provider Name | Maria Staed Dwyer |
First Address | Arlington Heights, IL 60004-6617 |
Second Address | Park Ridge, IL 60068-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 11/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07000-6676 | PT LICENSE (01) | IL |