Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070.009756 | IL |
NPI | 1184870495 |
---|---|
Provider Name | Mrs. Jami Ann Gruenloh |
First Address | Mascoutah, IL 62258-1736 |
Second Address | Mascoutah, IL 62258-1736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 18/08/2008 |