| NPI | 1407249774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH EVANS MCKENZIE Owner 318-715-7994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0012749) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2021-11-08 |