| NPI | 1225727944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ALAN MOORE Owner 346-646-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP2000X Clinic/Center Physical Therapy | |
| 261QP3300X Clinic/Center Pain | |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-05-08 |