| NPI | 1043672066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUPITER LABASAN CEO 575-441-4887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA 40587) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |