| NPI | 1306880414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ELMER Mangaer, Credentialing And Risk 815-381-7431 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology |
| 207X00000X Orthopaedic Surgery | |
| 207XS0106X Orthopaedic Surgery, Hand Surgery | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma | |
| 208100000X Physical Medicine & Rehabilitation | |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist, Orthopedic | |
| 225X00000X Occupational Therapist | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2026-07-10 |