Individual
MICHELLE RENAE GORETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
719 S OAKWOOD AVE, GENESEO, IL 61254-1756
(563) 650-7169
Mailing address
719 S OAKWOOD AVE, GENESEO, IL 61254-1756
(309) 944-5464
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160004145
IL
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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