| NPI | 1922751163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD SAMANIEGO Owner 224-368-7133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2022-01-28 |