| NPI | 1255060422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD WALDRON Authorized Official 332-242-6757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2022-06-06 |