Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070019607 | IL |
NPI | 1114473188 |
---|---|
Provider Name | Rebecca Van Landuyt |
First Address | Lombard, IL 60148-4830 |
Second Address | Lombard, IL 60148-4830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 30/08/2016 |