Individual
MARYBETH AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1706 E AMBER LN, URBANA, IL 61802-6907
(217) 328-0116
Mailing address
904 S VINE ST, URBANA, IL 61801-5013
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.002119
IL
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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