| NPI | 1245014125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STREETER Credentialing Specialist 800-699-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-11-19 |