| 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 |