Individual
JENIFER CARLOS DE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1415 SHERMAN AVE, APT. 605, EVANSTON, IL 60201-4453
(773) 817-2522
Mailing address
1415 SHERMAN AVENUE #605, EVANSTON, IL 60201
(773) 817-2522
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
070-009035
IL
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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