Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160-004014 | IL |
NPI | 1023015526 |
---|---|
Provider Name | Patrice Lassa |
First Address | Chicago, IL 60622-6036 |
Second Address | Chicago, IL 60622-6036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 12/05/2015 |