Individual
MRS. SALLY MARLENE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6504 E 129TH AVE, CROWN POINT, IN 46307-9087
(219) 662-7654
(219) 662-2136
Mailing address
2906 W 77TH AVE, MERRILLVILLE, IN 46410-4518
(219) 769-5904
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06000212A
IN
Other
Enumeration date
01/25/2007
Last updated
07/08/2007
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