Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160001189 | IL |
NPI | 1013153501 |
---|---|
Provider Name | Susan M Weingartner |
First Address | Homewood, IL 60430-4015 |
Second Address | Homewood, IL 60430-4015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 05/01/2009 |