| NPI | 1518672781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASEY MARIE BOSWELL Owner 502-550-0639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-03-05 |