| NPI | 1922647973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GAMBOA RIVERA Director/President 217-257-5283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2019-12-21 |
| Last Update Date | 2019-12-21 |