Individual
DIANE MAROLA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 S YORK ST, ELMHURST, IL 60126-5626
(630) 646-1141
Mailing address
1200 S YORK ST, ELMHURST, IL 60126-5626
(630) 646-1141
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160003333
IL
Other
Enumeration date
03/17/2008
Last updated
06/08/2025
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