| NPI | 1366728560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GAMBOA RIVERA Physical Therapist 1217-653-6814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2012-09-18 |