Individual
ANGELICA MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
508 W FRECH ST, STREATOR, IL 61364-1216
(815) 672-2600
Mailing address
215 E WASHINGTON ST, PONTIAC, IL 61764-2011
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160008659
IL
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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