Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 2073 | MS |
NPI | 1396383162 |
---|---|
Provider Name | Ms. Shelby Irene Presnell |
First Address | North Chicago, IL 60064-3048 |
Second Address | North Chicago, IL 60064-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2019 |
Last Update Date | 12/12/2019 |