Individual
KAYLA JANE BREEDLOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 N MAIN ST, NORMAL, IL 61761-1501
(309) 888-5380
Mailing address
117 S CHESTNUT ST, LE ROY, IL 61752-1782
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009226
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160009226
—
IL
Enumeration date
12/02/2021
Last updated
12/02/2021
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