Individual
HOLLIS S LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2611 W CHICAGO AVE, CHICAGO, IL 60622-4519
(773) 395-9900
Mailing address
714 COLUMBIAN AVE, OAK PARK, IL 60302-1556
(708) 380-9553
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.003183
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070.003183
STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
02/06/2018
Last updated
02/06/2018
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