| NPI | 1912338062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WILLIAM HANLEY Owner 815-436-1988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036072380) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036072380) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2014-09-24 |