Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT870484 | DC |
Y | 2251X0800X | Physical Therapist - Orthopedic | 070.016162 | IL |
NPI | 1033272760 |
---|---|
Provider Name | Marisa Alonso |
First Address | Homer Glen, IL 60491-6705 |
Second Address | Homer Glen, IL 60491-6705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2006 |
Last Update Date | 24/07/2009 |