| NPI | 1487796454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY D GOFF Co Owner 302-734-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: DE 2005212081) |
| Additional Taxonomies | 225XP0200X Occupational Therapist Pediatrics (Licence: DE 2005212081) |
| 235Z00000X Speech-Language Pathologist (Licence: DE 2005212081) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-08-22 |