Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL |
NPI | 1003017948 |
---|---|
Provider Name | Mrs. Marie Ann Dicosola |
First Address | Hinsdale, IL 60521-3730 |
Second Address | Hinsdale, IL 60521-3730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |