Individual
MRS. AMY JO E LARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-2690
Mailing address
1613 BURNING TREE DR, DECATUR, IL 62521-9151
(217) 865-2637
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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