Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070002790 | IL |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1023331790 |
---|---|
Provider Name | Ms. Miriam Boelen |
First Address | Glenview, IL 60026-1301 |
Second Address | Glenview, IL 60026-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2010 |
Last Update Date | 12/03/2010 |