| NPI | 1477900629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CONLIFFE Owner 502-639-8722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 363AM0700X Physician Assistant Medical | |
| 213E00000X Podiatrist | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2025-09-03 |