| NPI | 1013134824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J. ROSS Manager 478-474-0240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 007019) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT000866) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2009-04-08 |