| NPI | 1043769615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM MALLON Physical Therapist 757-812-3288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: VA 2305204928) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2016-09-23 |