| NPI | 1528620127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED WAYNE Member 219-510-2256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2023-07-24 |