| NPI | 1093115016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLA BURRELL Credentialing Coordinator 888-590-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 654940011) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2014-08-27 |