Individual
SHIBU PORINCHU PERUMBULLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9725 S KARLOV AVE, OAK LAWN, IL 60453-3388
(708) 422-1461
Mailing address
9725 S KARLOV AVE, OAK LAWN, IL 60453-3388
(708) 422-1461
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005937
IL
Other
Enumeration date
04/20/2012
Last updated
04/20/2012
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