| NPI | 1134941560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK FICKLING Senior Payer Relations Manager 888-580-6180 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |