| NPI | 1063768455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY CAMERON WALLACE Manager 970-977-6239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics |
| Additional Taxonomies | 225XG0600X Occupational Therapist Gerontology |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |