| NPI | 1518986736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA A. BUGGS Clinic Administrator 662-578-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-22 |