| NPI | 1487465217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIONNA K CRUME Owner 870-636-4438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-01-20 |