| NPI | 1134326739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAT MANGUM CEO 469-688-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1030278) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 14136) |
| 208D00000X General Practice (Licence: TX J1957) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2009-04-22 |