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Individual
KATHERINE WAX
Active
Individual
KATHERINE WAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-014502
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1623066
BCBS PROVIDER #
IL
01
—
367885100
US DEPT OF LABOR PROV #
IL
01
—
CJ4383
R.R. MEDICARE GRP#
IL
01
—
P00238078
R.R. MEDICARE PIN #
IL
Enumeration date
10/13/2006
Last updated
09/24/2013
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