Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1124511159 |
---|---|
Provider Name | Molly Victorine |
First Address | Hoffman Estates, IL 60169-1225 |
Second Address | Hoffman Estates, IL 60169-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |