Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | IL |
NPI | 1063680874 |
---|---|
Provider Name | Yafa C Wiesman |
First Address | Chicago, IL 60659-5113 |
Second Address | Chicago, IL 60659-5113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 14/02/2008 |