| NPI | 1326155250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORI R MANNON Owner 505-744-5187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NM #2194) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-10-05 |