Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070012791 | IL |
NPI | 1003143595 |
---|---|
Provider Name | Mr. Oscar Jude |
First Address | Joliet, IL 60435-8716 |
Second Address | Joliet, IL 60435-8716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2009 |
Last Update Date | 04/11/2009 |