Individual
CAROL LYNN NEPOMUCENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3936 N MILWAUKEE AVE, CHICAGO, IL 60641-2703
(630) 368-1771
(708) 658-2750
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070006287
IL
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070-006287
LICENSE #
IL
Enumeration date
08/29/2006
Last updated
09/20/2023
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