| NPI | 1003020421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE M. DIFRAKHSH Physical Therapist 678-983-5304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA PT007856) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2020-08-22 |