Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160002068 | IL |
NPI | 1003122516 |
---|---|
Provider Name | Ms. Heather Ann Robinson |
First Address | Godfrey, IL 62035-1523 |
Second Address | Godfrey, IL 62035-1523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2010 |
Last Update Date | 20/08/2010 |