| NPI | 1700104833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSI MICHELE THOMSON Credentaling Specialist 309-743-2070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2018-05-07 |