| NPI | 1134844848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CHURCH VP Of Finance 618-972-5228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2023-12-14 |