| NPI | 1518587708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EDWIN CROUSE Owner 606-784-7551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Additional Taxonomies | 225100000X Physical Therapist |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2022-06-22 |