Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.006066 | IL |
NPI | 1003026188 |
---|---|
Provider Name | Mrs. Linda Sue Roherty |
First Address | South Elgin, IL 60177-2307 |
Second Address | Elgin, IL 60123-4912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 23/08/2012 |