Organization
GRANITE CITY PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE MOORE DPT (OWNER)
(317) 691-6262
Entity
Organization
Contact information
Practice address
400 A ST STE D, GRANITE CITY, IL 62040-1891
(618) 452-8561
Mailing address
3008 HUNTSVILLE DR, GLEN CARBON, IL 62034-3046
(317) 691-6262
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
070018656
IL
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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