| NPI | 1043267289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY ALLYN MOSSBURG Athletic Trainer 765-455-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2020-08-22 |