Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070003543 | IL |
NPI | 1104149129 |
---|---|
Provider Name | Mrs. Karen Henrickson |
First Address | Glenview, IL 60025-1812 |
Second Address | Glenview, IL 60026-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2010 |
Last Update Date | 04/03/2010 |