| NPI | 1104056548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY E BOLDT CFO 309-743-2070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2011-01-25 |