| NPI | 1205809431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERON J BLAND Owner/President 985-876-9555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 00677) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: LA Z10831) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-08-22 |