| NPI | 1003114083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHEDA BROUGHTON Manger, Credentialing 252-248-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2024-11-25 |