| NPI | 1114507852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE B WALL Owner 254-592-0418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2022-06-15 |