Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.008420 | IL |
NPI | 1013562651 |
---|---|
Provider Name | Tyla Hughes |
First Address | Moline, IL 61265-3018 |
Second Address | Prophetstown, IL 61277-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2019 |
Last Update Date | 08/08/2019 |