Individual
MARIE LOUISE ILLIUS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5700 LOMBARDO CTR, ROCK RUN NORTH SUITE 205, SEVEN HILLS, OH 44131-2540
(216) 447-1149
Mailing address
33865 BROKAW RD, COLUMBIA STATION, OH 44028-9779
(440) 748-3674
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA.04976
OH
Other
Enumeration date
05/05/2006
Last updated
07/08/2007
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