Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.020540 | IL |
NPI | 1003232455 |
---|---|
Provider Name | Sara Townsend |
First Address | Maryville, IL 62062-5828 |
Second Address | Highland, IL 62249-1282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 10/03/2014 |