| NPI | 1518774553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN IAN WELLER Owner 480-874-6808 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2024-12-13 |
| Last Update Date | 2024-12-13 |