| NPI | 1073001913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER WILSON Credentialing Manager 502-272-3463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-11-14 |