| NPI | 1184774598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MOORE Administrator 276-935-6496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305003200) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2015-04-08 |