| NPI | 1407244916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANAEL PHILIP SORUM Owner/President 414-429-3030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1170424) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |