| NPI | 1497027775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA MARIE BROADWATER Executive Director 601-983-7494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |