| NPI | 1194452409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DAVENPORT COO 479-587-3149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-08-05 |