| NPI | 1104951698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER SMITH Credentialing Agent 815-965-8505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036111300) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2014-08-07 |