Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070 006315 | IL |
NPI | 1003001249 |
---|---|
Provider Name | Mr. Ronnie Lee Day |
First Address | Danville, IL 61832-1159 |
Second Address | Danville, IL 61832-1159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070 006315 | STATE LICENCE NUMBER (01) | IL |