Individual
HOLLY SUZANNE HARTLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
105 E LEWIS ST, ANNA, IL 62906-1724
(618) 697-3073
Mailing address
105 E LEWIS ST, ANNA, IL 62906-1724
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004359
IL
Other
Enumeration date
01/14/2011
Last updated
01/14/2011
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