| NPI | 1164829073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLA BURRELL Credentialing Coordinator 888-590-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 676950000) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2016-06-16 |