| NPI | 1356814024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYNDA RAY President/Owner 618-599-0743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2019-01-05 |
| Last Update Date | 2019-01-13 |