Individual
ELCY DESMANGLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 N LAKE SHORE DR, CHICAGO, IL 60657-5640
(773) 665-3184
Mailing address
1904 W MORSE AVE APT 1, CHICAGO, IL 60626-3112
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160000594
IL
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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