| NPI | 1376411413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA S TYLER Provider Enrollment Manager 804-528-1548 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-10-29 |