| NPI | 1154795755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDALYNE ROMA Owner/Physical Therapist 928-301-0762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225XP0200X Occupational Therapist Pediatrics | |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |