Individual
TRACI WALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20379 E 1100TH AVE, DIETERICH, IL 62424-2114
(217) 663-2876
Mailing address
20379 E 1100TH AVE, DIETERICH, IL 62424-2114
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160006981
IL
Other
Enumeration date
04/20/2016
Last updated
04/20/2016
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