| NPI | 1265972772 |
|---|---|
| Doing Business As | MODOMA |
| Entity Type | Organization |
| Authorized Contact | JASON MARCHETTI Owner 469-304-3443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX L7470) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2023-05-02 |