| NPI | 1528670775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER WILSON National Credentialing Manager 502-272-3463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2022-03-28 |