| NPI | 1174118103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DAVID CHURCH Vice President 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 | 2021-03-02 |
| Last Update Date | 2024-09-06 |