| NPI | 1447744461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER WILSON National Credentialing Manager 502-272-3463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2022-03-28 |