| NPI | 1326630344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ELISE CANDELA Owner 810-577-3129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-02-17 |