| NPI | 1508943770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLA D BURRELL Credentialing Coordinator 888-590-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-02-29 |