| NPI | 1457764623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN PRUE Member 860-208-5382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NC 14896) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-08-23 |