| NPI | 1386012870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT MICHUDA Owner 260-241-7887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: AZ 11779) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |