| NPI | 1366212268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES JERMAN Member 731-234-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics |
| 235Z00000X Speech-Language Pathologist, | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-01-03 |