Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070016954 | IL |
NPI | 1003171133 |
---|---|
Provider Name | Monelyn R Rabago |
First Address | Streator, IL 61364-2833 |
Second Address | Streator, IL 61364-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2012 |
Last Update Date | 19/08/2012 |