Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160000778 | IL |
NPI | 1003122912 |
---|---|
Provider Name | Mrs. Glenda Gail Miller |
First Address | Windsor, IL 61957-1623 |
Second Address | Windsor, IL 61957-1623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 30/08/2010 |