Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070019096 | IL |
NPI | 1154722916 |
---|---|
Provider Name | Riza Acas |
First Address | Elgin, IL 60124-4322 |
Second Address | Elgin, IL 60124-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2014 |
Last Update Date | 11/09/2014 |