| NPI | 1700596442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISSA SORRELLS Owner 217-248-5795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| 225200000X Physical Therapy Assistant | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |