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Organization
SPRING GROVE PHYSICAL MEDICINE AND REHABILATATION LTD
Active
Organization
SPRING GROVE PHYSICAL MEDICINE AND REHABILATATION LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH DESTEPHANO DESTEPHANO (PRESIDENT)
(815) 675-0675
Entity
Organization
Contact information
Practice address
2100 ROUTE 12, SUITE 101, SPRING GROVE, IL 60081
(815) 675-0675
Mailing address
2100 ROUTE 12, SUITE 101, SPRING GROVE, IL 60081
(815) 675-0675
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
IL
225100000X
Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05632013
BLUE CROSS NUMBER
IL
Enumeration date
01/18/2007
Last updated
09/11/2025
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