| NPI | 1518276120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA JEAN FERNANDES Administrator 708-420-1604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070006470) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |