| NPI | 1053175174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY MCCALL Credentialing 479-201-6091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-02-08 |