| NPI | 1063957298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISITN IBACH OWEN President 904-434-5673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: FL PT6722) |
| Enumeration Date | 2016-12-26 |
| Last Update Date | 2016-12-29 |