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Individual

WILLIE D MERRILL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1806 S HIGHLAND AVE, LOMBARD, IL 60148-4938
(312) 604-3704
Mailing address
2412 S 23RD AVE, BROADVIEW, IL 60155-3809
(708) 829-6421

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005917
IL

Other

Enumeration date
01/17/2013
Last updated
01/17/2013
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