| NPI | 1295008712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE J IVANICKY Owner/President 225-753-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |