| NPI | 1346777943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK A DAVIS Owner Manager/Physician Assistant 754-205-6873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2021-10-18 |