| NPI | 1437776036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK RICHARD Owner 985-626-1671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 111N00000X Chiropractor |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2021-01-19 |