| NPI | 1386836120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIEDRA ROBINSON Credentialing Manager 817-284-9850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC MD15580) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2018-07-31 |