| NPI | 1174151997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN THOMPSON Practice Manager 817-739-0433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2023-01-02 |