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RUSSA AUSSIEKER PTA

>> Physical Therapy Assistant >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1497076103

Individual Registrant:
 RUSSA  AUSSIEKER PTA
Gender: F
Sole Proprietor

Location and contact information for practice:
201 LOCUST ST  MINONK, IL 61760-1511 US
Tel: 309-432-2557  Fax: 309-432-3330

Contact information for business:
550 FRONTAGE RD SUITE 2415 NORTHFIELD, IL 60093-1202 US
Tel: 847-441-5593  Fax: 847-441-0734

Registration Information:
NPI: 1497076103
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225200000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapy Assistant
IL160003378

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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