Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070021637 | IL |
NPI | 1003272550 |
---|---|
Provider Name | Melissa Myers |
First Address | Lisle, IL 60532-1353 |
Second Address | Lisle, IL 60532-1353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2016 |
Last Update Date | 13/01/2016 |