Individual
ANKIT MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
901 FLORSHEIM DR, LIBERTYVILLE, IL 60048-5200
(616) 796-4637
Mailing address
18245 W BANBURY DR, GURNEE, IL 60031-4580
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.006636
IL
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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