| NPI | 1124495932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA TRAYLOR Director 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2025-06-16 |