| NPI | 1447871702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER WILSON National Credentialing Manager 502-272-3463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-09-26 |