| NPI | 1740811413 |
|---|---|
| Former Legal Business Name | SSPTINC |
| Entity Type | Organization |
| Authorized Contact | VINCENT GUTIERREZ President 815-210-4869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-01-30 |