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Organization

HOME CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SHANE T STACHURA PT, DPT, CLT (MEMBER MANAGER)
(708) 227-8403
Entity
Organization

Contact information

Practice address
109 S 3RD ST, BUCKLEY, IL 60918-7044
(708) 227-8403
Mailing address
PO BOX 24, BUCKLEY, IL 60918-0024
(708) 227-8403

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary

Other

Enumeration date
03/15/2019
Last updated
03/15/2019
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