| Organization Name: | WABASH CHRISTIAN THERAPY AND MEDICAL CLINIC LLC |
| NPI Number: | 1255755344 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIMOTHY PHILLIPPE (CEO) |
| Mailing Address: | 1112 Oak St Carmi |
| State: | IL US |
| Postal Code: | 628211344 |
| Phone Number: | 2177325155 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2014 |
| NPI Last Update Date: | 12/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |