| NPI | 1154740975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AJEET S CHARATE Manager / Clinician 815-931-0047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.005140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070009590) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2014-04-09 |