Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070.007511 | IL |
NPI | 1669711776 |
---|---|
Provider Name | Ms. Meena Renganathan |
First Address | Oak Forest, IL 60452-4006 |
Second Address | Oak Forest, IL 60452-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2013 |
Last Update Date | 08/02/2013 |