Provider Demographics
NPI:1245558063
Name:HOWELL, DENISE L (PTA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 E AMBER LN
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-6997
Mailing Address - Country:US
Mailing Address - Phone:217-344-4607
Mailing Address - Fax:217-344-4608
Practice Address - Street 1:1704 E AMBER LN
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-6997
Practice Address - Country:US
Practice Address - Phone:217-344-4607
Practice Address - Fax:217-344-4608
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003681225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant