Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05011221A | IN |
NPI | 1003240664 |
---|---|
Provider Name | Rachel Tatham |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Columbus, IN 47201-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 18/02/2015 |