| NPI | 1487289013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH L HEATHERLY Biller 347-933-6740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2021-09-09 |