| NPI | 1215028618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAIN MACKAY Owner 225-751-3696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 00619) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 01455F) |
| 225100000X Physical Therapist (Licence: LA 00356) | |
| 225100000X Physical Therapist (Licence: LA 02040F) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |