| NPI | 1194554360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA MARSHAE WILLIS Owner 773-967-0550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-07-29 |