| NPI | 1285797746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTE PAYNE Office Manager 317-776-1061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2023-08-09 |