| NPI | 1487308656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL BELL Owner 657-204-6069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-07 |