Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070015178 | IL |
NPI | 1013157403 |
---|---|
Provider Name | Mrs. Ermina Ang Doroin |
First Address | Worth, IL 60482-1244 |
Second Address | Chicago, IL 60649-3835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2009 |
Last Update Date | 10/04/2010 |