Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160004154 | IL |
NPI | 1013168319 |
---|---|
Provider Name | Yvonne D Wallace-Robinson |
First Address | Evanston, IL 60201-3353 |
Second Address | Evanston, IL 60201-3353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2008 |
Last Update Date | 05/10/2008 |