Individual
MRS. IDA RIVA JAMANDRON CARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 351-4926
Mailing address
803 1/2 W PECAN ST, APT. C, CARBONDALE, IL 62901-1483
(618) 201-9459
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070016280
IL
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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