| NPI | 1306901020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS ALAN MANTOOTH General Manager 270-259-0551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-08-22 |