Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070024113 | IL |
N | 2251N0400X | Physical Therapist - Neurology | 1590 | NE |
NPI | 1114581204 |
---|---|
Provider Name | Sherri Lynn Alvarez |
First Address | Peoria, IL 61603-3255 |
Second Address | Peoria, IL 61603-3255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |