| NPI | 1437458536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE M LONGO Owner 931-905-1720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 111N00000X Chiropractor |
| 225100000X Physical Therapist | |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2011-08-01 |