| NPI | 1477886232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN DAVID BRAULT Owner 971-570-5043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: OR 4970) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: OR 5680) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2013-07-17 |