| NPI | 1457888943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNANNA C SULLIVAN Owner 719-659-6088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-5810) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2019-07-18 |