| NPI | 1083229793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARISA ODELL Payer Director 866-806-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2023-01-05 |