| NPI | 1114637865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY TUCKER Co Owner 870-930-5832 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2022-12-02 |