| NPI | 1952676694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN B MUSHOLT Physical Therapist 217-228-2262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 70005018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2006005286) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |