| NPI | 1477689305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE JOHN IVANICKY Owner 225-766-5050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: LA 024904) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-08-22 |