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1467877118
MAXIMINO WILDE
GLENVIEW, IL
NPI
1467877118
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: IL 1600006607)
Enumeration Date
2014-03-04
Last Update Date
2014-03-04
Business Address
-- MAXIMINO WILDE
3703 W LAKE AVE
GLENVIEW, IL 60026-5823
Phone number: 847-904-5022
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Mailing Address
-- MAXIMINO WILDE
8059 E PRAIRIE RD
SKOKIE, IL 60076-3446
Phone number: 773-678-6718
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