| NPI | 1306448600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARYN HAGLUND Credentialing COO Rdinator 631-359-5780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2020-11-11 |