| NPI | 1386036119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETINA K BASSO PT 605-415-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: SD 0963) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2015-03-03 |