Individual
MS. TARA SUE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3631 S 6TH ST, SPRINGFIELD, IL 62703-4777
(217) 535-3685
Mailing address
3631 S 6TH ST, SPRINGFIELD, IL 62703-4777
(217) 535-3685
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
IL
Other
Enumeration date
02/22/2008
Last updated
02/22/2008
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