Individual
HANNA BASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
191 E QUEENWOOD RD, MORTON, IL 61550-2956
(309) 266-5331
Mailing address
110 W LAKELAND RD, APARTMENT 605, MORTON, IL 61550-1425
(615) 521-1672
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070018416
IL
Other
Enumeration date
08/04/2013
Last updated
08/04/2013
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