Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160005374 | IL |
NPI | 1003112756 |
---|---|
Provider Name | Mary Kalert |
First Address | Harrisburg, IL 62946-2637 |
Second Address | Herrin, IL 62948-3631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 03/04/2019 |