Individual
BRYLENE LAVELLE PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10400 S ROBERTS RD, PALOS HILLS, IL 60465-1972
(219) 308-4891
Mailing address
15301 KNOX AVE APT 4, OAK FOREST, IL 60452-2542
(210) 780-0854
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009225
IL
Other
Enumeration date
04/20/2021
Last updated
04/20/2021
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