| NPI | 1760706162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN DAVID WEIDNER Certified Athletic Trainer 847-322-4518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 096.002850) |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2010-03-15 |