| NPI | 1376103622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRISHA E MCCAULEY Clinician 678-829-6077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2019-06-19 |