Individual
MRS. SAMANTHA JAE VAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, PTA, RYT-200
Contact information
Practice address
900 N WESTMORELAND RD, LAKE FOREST, IL 60045-1674
(630) 933-1500
Mailing address
4850 KINGS WAY W, GURNEE, IL 60031-3255
(812) 449-2558
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.009775
IL
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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