Individual
MARY B JESSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1830 S 44TH ST, DECATUR, IL 62521-5147
(217) 423-2784
Mailing address
205 W WALL ST, MOWEAQUA, IL 62550-1151
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
070007130
IL
Other
Enumeration date
08/25/2010
Last updated
08/26/2010
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