| NPI | 1316252968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GIBSON VICK Owner 270-860-5128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2020-06-11 |