| NPI | 1174892798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR MANUEL MACIAS General Manager 757-240-7848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 220993) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025085) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2011-12-28 |