| NPI | 1184181935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE ZIMMER Credentialing Specialist 512-800-3659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| 2251X0800X Physical Therapist Orthopedic | |
| 261QP2000X Clinic/Center Physical Therapy | |
| 261QX0100X Clinic/Center Occupational Medicine | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2019-02-28 |