Individual
JENNIFER MAPLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-2690
Mailing address
2300 N EDWARDS, DECATUR, IL 62526-9999
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160005489
—
IL
Enumeration date
07/18/2012
Last updated
07/18/2012
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