| NPI | 1124787437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA MARIE EBERSOLE Owner/Manager 623-759-1668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111N00000X Chiropractor |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2022-01-25 |