| NPI | 1023306669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FORREST L WAIDE Director 270-824-9227 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |