Healthcare Provider Details

I. General information

NPI: 1407054604
Provider Name (Legal Business Name): RCI, (WRS, INC.)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W SAINT LOUIS ST STE 3
WEST FRANKFORT IL
62896-1968
US

IV. Provider business mailing address

502 W SAINT LOUIS ST STE 3
WEST FRANKFORT IL
62896-1968
US

V. Phone/Fax

Practice location:
  • Phone: 618-937-6200
  • Fax:
Mailing address:
  • Phone: 618-937-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LAUREN MARIE MEDINA
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 618-937-6200