| NPI | 1245908557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE C SPENCER Credentialing Specialist 757-966-2398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2021-09-01 |