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Organization
SPRING GROVE PHYSICAL THERAPY LTD
Active
Organization
SPRING GROVE PHYSICAL THERAPY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH DESTEPHANO (PRESIDENT)
(815) 675-0675
Entity
Organization
Contact information
Practice address
2100 ROUTE 12, SUITE101, SPRING GROVE, IL 60081
(815) 675-0675
Mailing address
2100 ROUTE 12, SUITE101, SPRING GROVE, IL 60081
(815) 675-0675
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
042618917
IL
Other
Enumeration date
11/05/2007
Last updated
11/05/2007
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