| NPI | 1154895282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASWANDRA GRAYDON Owner 469-774-9496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| 133N00000X Nutritionist | |
| 225700000X Massage Therapist | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2019-01-11 |