| NPI | 1144818147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE KELLY Physical Therapist 121-468-6295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-08-09 |