| NPI | 1164902409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY CORBETT Office Manager 512-347-8881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 111N00000X Chiropractor | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| 208VP0000X | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-09-25 |