| NPI | 1992874416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL KETTLER Office Manager 618-277-6282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070004745) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2008-06-18 |