Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160000352 | IL |
NPI | 1003432964 |
---|---|
Provider Name | Tracy Lynn Kurfman |
First Address | Quincy, IL 62301-2834 |
Second Address | Golden, IL 62339-1055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2020 |
Last Update Date | 17/06/2020 |