| NPI | 1205146750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY BULLOCK Manager 267-736-9099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017291) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC009582) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2010-10-18 |