| NPI | 1235796228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKOLAS HETHERINGTON Owner 989-450-6441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2021-08-11 |