| NPI | 1669652897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH DESTEPHANO President 815-675-0675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 042618917) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |