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Individual

MRS. CAROLE FORTMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
1219 W ROOSEVELT RD, MAYWOOD, IL 60153-4046
(708) 216-5300
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-5300

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070007201
IL

Other

Enumeration date
08/07/2012
Last updated
08/07/2012
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