Individual
MRS. KERMALENE MARIE ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5006 MEMORY TRL, MCHENRY, IL 60051-7778
(847) 497-3264
Mailing address
5006 MEMORY TRL, MCHENRY, IL 60051-7778
(847) 497-3264
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004012
IL
Other
Enumeration date
05/30/2012
Last updated
05/30/2012
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