Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070.015686 | IL |
NPI | 1285259507 |
---|---|
Provider Name | Mrs. Sheila Valencia Punzalan |
First Address | Skokie, IL 60076-3609 |
Second Address | Skokie, IL 60076-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 11/06/2020 |