Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 05013690A | IN |
N | 2251G0304X | Physical Therapist - Geriatrics | 070015824 | IL |
NPI | 1215690243 |
---|---|
Provider Name | Marie Grace Healy |
First Address | Hobart, IN 46342-2028 |
Second Address | South Holland, IL 60473-3788 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2021 |
Last Update Date | 17/10/2021 |