Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 070018346 | IL |
NPI | 1063766699 |
---|---|
Provider Name | Ms. Rachel Lynn Perry |
First Address | Libertyville, IL 60048-3204 |
Second Address | Libertyville, IL 60048-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2012 |
Last Update Date | 05/11/2012 |