Individual
MRS. DIANE BURNICKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L/PTA
Contact information
Practice address
6807 W 114TH ST, WORTH, IL 60482-2012
(708) 671-0858
Mailing address
6807 W 114TH ST, WORTH, IL 60482-2012
(708) 671-0858
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.002555
IL
Other
Enumeration date
12/23/2011
Last updated
12/23/2011
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