Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
May 23, 2022
License(s)
040925-01 (NY), 070.024114 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 325 E 13TH ST | Gibson City, IL 60936-1104 | 929-213-5523 |
| LOCATION | 1001 E PELLS ST | Paxton, IL 60957-1300 | 217-379-4361 |
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