| NPI | 1174741037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA JOHNSON Treasurer 229-300-3241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |