Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 070013804 | IL |
NPI | 1497007587 |
---|---|
Provider Name | Stephanie L. Vodopic |
First Address | Chicago, IL 60612-7232 |
Second Address | Chicago, IL 60612-7232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
376000511 | (05) | IL |