| NPI | 1124816004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLEISCHA MAYNE-OWEN Office Manager 407-312-4613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 225100000X Physical Therapist | |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-09-25 |