Individual
KARIN MYRVOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2662 MCFARLAND RD, ROCKFORD, IL 61107-6806
(815) 751-4255
Mailing address
2662 MCFARLAND RD, ROCKFORD, IL 61107-6806
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005521
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160005521
PROFESSIONAL LICENSE
IL
Enumeration date
09/02/2010
Last updated
09/05/2012
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