Individual
MRS. BRENDA JOY LARSON PITTACORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
412 W 31ST ST, CHICAGO, IL 60616-3116
(312) 225-3119
(312) 225-3219
Mailing address
412 W 31ST ST, CHICAGO, IL 60616-3116
(312) 225-3119
(312) 225-3219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
160001451
IL
Other
Enumeration date
06/01/2010
Last updated
06/01/2010
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