Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070002291 | IL |
NPI | 1003080029 |
---|---|
Provider Name | Ms. Daryl Federman |
First Address | Northbrook, IL 60062-1506 |
Second Address | Glenview, IL 60026-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 22/04/2008 |