Individual
REBECCA STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
431 REMINGTON BLVD, BOLINGBROOK, IL 60440-4918
(630) 759-1112
Mailing address
17008 W 147TH ST, LOCKPORT, IL 60441-6203
(815) 931-3323
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160007985
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160007985
PHYSICAL THERAPY ASSISTANT
IL
Enumeration date
04/24/2022
Last updated
04/24/2022
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