| NPI | 1336127117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL NICOLE VAUGHN Credentialing Specialist 630-920-4670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070007675) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2024-09-17 |