| NPI | 1083068456 |
|---|---|
| Doing Business As | SHADY GROVE CENTER |
| Entity Type | Organization |
| Authorized Contact | MICHAEL T. BERG Assistant Secretary 505-468-4752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 15009) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MD 15009) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2017-09-07 |