| NPI | 1154408318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLA BURRELL Contracting & Credentialing Manager 888-590-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2017-02-17 |