Individual
ILISE DEVINE MEARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3359
AZ
225100000X
Physical Therapist
Primary
PT00010344
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86059251885711A007
TRICARE
AZ
Enumeration date
06/28/2005
Last updated
06/27/2019
Update your record
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