| NPI | 1952549198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERICK M RUSSELL President 708-660-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 070013337) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2009-03-02 |