| NPI | 1174261499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARREATTA BLACKMON Chief Executive Officer 502-235-4712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2022-05-25 |