Individual
JESSICA WALLBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1525 E MAIN ST, STREATOR, IL 61364-3162
(815) 672-4516
Mailing address
1525 E MAIN ST, STREATOR, IL 61364-3162
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
160.008001
IL
225200000X
Physical Therapy Assistant
Primary
160008001
IL
Other
Enumeration date
02/22/2019
Last updated
02/22/2019
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