| NPI | 1275238149 |
|---|---|
| Former Legal Business Name | MAGNOLIA PEDIATRIC THERAPY, LLC |
| Entity Type | Organization |
| Authorized Contact | LACEY K QUINBY Owner 229-329-7409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2024-06-05 |