Healthcare Provider Details

I. General information

NPI: 1174715650
Provider Name (Legal Business Name): ULTIMATE THERAPEUTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 STATE HIGHWAY 14
CHRISTOPHER IL
62822
US

IV. Provider business mailing address

101 PARK CIR
BENTON IL
62812-3464
US

V. Phone/Fax

Practice location:
  • Phone: 618-724-7456
  • Fax: 618-724-7492
Mailing address:
  • Phone: 618-724-7456
  • Fax: 847-572-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN N RICE
Title or Position: OWNER
Credential:
Phone: 618-724-7456