| NPI | 1487133658 |
|---|---|
| Other Name | FICTITIOUS BUSINESS NAME |
| Entity Type | Organization |
| Authorized Contact | AMANDA DEROSA Physical Therapist 928-607-4037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 293767) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |