Individual
BRENDA J TATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1010 FAIRWAY DR, FREEPORT, IL 61032
(815) 599-6000
Mailing address
1045 W STEPHENSON ST, PO BOX 857, FREEPORT, IL 61032-4864
(815) 599-6000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160002443
IL
Other
Enumeration date
02/23/2009
Last updated
02/23/2009
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