| NPI | 1194291518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY LARSON Owner 225-939-9797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics |
| 225200000X Physical Therapy Assistant | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |