Jessica Wallbaum

NPI #1962969246 in Streator, Illinois

Provider Information

NPI Number: 1962969246
Entity Type: Individual
Name: Jessica Wallbaum
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Feb 22, 2019
Last Updated: Feb 22, 2019

Practice Location

Address: 1525 E MAIN ST
City: Streator
State: Illinois
ZIP Code: 61364-3162
Phone: (815) 672-4516

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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