| NPI | 1649322017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY L. MAURER Owner Physical Therapist 618-524-8634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070012276) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 003951) |
| 225800000X Recreation Therapist (Licence: IL 160002834) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-08-22 |