| NPI | 1225404205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK A LEIST Office Manager 615-636-5923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: TN 2649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10999) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2017-01-22 |