Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1070 | IL |
NPI | 1841412822 |
---|---|
Provider Name | Mrs. Marianne P. Vuckovich |
First Address | Deerfield, IL 60015-3328 |
Second Address | Lake Forest, IL 60045-1282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |