| NPI | 1003465147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SIMONTON Provider Enrollment 605-541-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 261QH0700X Clinic/Center, Hearing and Speech |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2022-04-29 |