| NPI | 1386995520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOYER Credentialing Manager 502-538-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QP2000X Clinic/Center Physical Therapy | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2024-09-23 |