| NPI | 1518339001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL VAN CAMP LOTT Owner / President 251-990-9082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH-3828) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: AL PTH-3828) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH-3828) | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2020-04-16 |