| NPI | 1659994911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DERRY CEO 309-267-9873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-05-29 |