| NPI | 1073816112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WARD HENNE President 678-491-4729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: GA PT007124) |
| Enumeration Date | 2010-12-12 |
| Last Update Date | 2011-01-11 |