| NPI | 1700609047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY SOUTHERS Owner, Physical Therapist 815-901-1198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-12 |