| NPI | 1124859343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing And Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QR0400X Clinic/Center Rehabilitation |
| 207X00000X Orthopaedic Surgery | |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2025-07-22 |