| NPI | 1275194417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELSY CELIS Credentialing 817-673-9354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| 225100000X Physical Therapist | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-10-03 |