Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 070005895 | IL |
NPI | 1073521852 |
---|---|
Provider Name | Ms. Lisa Gale Lettiere |
First Address | Skokie, IL 60077-2269 |
Second Address | Skokie, IL 60077-2269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/12/2016 |