| NPI | 1013422070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA LATOCHA Credentialing Coordinator 410-749-4154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2019-08-20 |