| NPI | 1306157896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST RICHARD LEDESMA Provider/President 912-401-0443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT003700) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2022-07-21 |