| NPI | 1417505678 |
|---|---|
| Doing Business As | SOURCE THERAPY |
| Entity Type | Organization |
| Authorized Contact | DWAN AYALA Credentialing Coordinator 425-450-9474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2019-08-30 |