| NPI | 1083854087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA MARIE ANDERSON CEO/Owner 985-218-9556 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2014-04-02 |