Organization Name: | AMG PHYSICAL REHABILITATION, LLC |
NPI Number: | 1831463595 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTOPHER A GARN (MANAGER-LLC CLINIC DIRECTOR) |
Mailing Address: | 1601 E Main St Suite D St Charles |
State: | IL US |
Postal Code: | 601742387 |
Phone Number: | 6303777505 |
Fax Number: | 6303777532 |
NPI Enumeration Date: | 02/28/2012 |
NPI Last Update Date: | 04/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |