MS. Mae O Pedroso Provo

NPI #1225210073 in Tinley Park, Illinois

Provider Information

NPI Number: 1225210073
Entity Type: Individual
Name: MS. Mae O Pedroso Provo
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Enumeration Date: Dec 4, 2007
Last Updated: Dec 4, 2007

Practice Location

Address: 6711 PINE LAKE DR
City: Tinley Park
State: Illinois
ZIP Code: 60477-4935
Phone: (630) 272-1788

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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