Individual
THERESA WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
800 E CARPENTER ST, SPRINGFIELD, IL 62769-1000
(217) 544-6464
Mailing address
1229 W URBAN ST, SPRINGFIELD, IL 62704-4919
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160003831
IL
Other
Enumeration date
06/19/2013
Last updated
06/19/2013
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