| NPI | 1356045058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE WALLENS Accounting Manager 386-255-4568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-04-03 |