Individual
ILLONA SUSAN BROSSMANMCINTIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3143
MA
225100000X
Physical Therapist
5623
SC
225100000X
Physical Therapist
PT02088
RI
Other
Enumeration date
02/23/2007
Last updated
04/26/2009
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