Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 070.021996 | IL |
NPI | 1033658356 |
---|---|
Provider Name | Maryrose Guevara |
First Address | Chicago, IL 60625-1314 |
Second Address | Chicago, IL 60659-4722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2017 |
Last Update Date | 20/02/2017 |