| NPI | 1356419493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIA FULLER Owner 678-992-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA pt006934) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA pt006067) |
| 225X00000X Occupational Therapist (Licence: ot000932) | |
| 225XH1200X Occupational Therapist, Hand (Licence: GA otooo932) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2008-08-20 |