| NPI | 1376928556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD MARC WIST Owner/President 410-213-7878 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23989297) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2015-07-29 |