| NPI | 1003080813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON SCROGHAM Office Manager 1208-522-4481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-343) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2008-06-18 |