| NPI | 1073279287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDTRAIL FEET Owner 813-797-6174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2024-04-23 |