| NPI | 1255111324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT PAULO FORMALEJO PANGANIBAN Managing Member/Owner 541-887-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2024-08-26 |