| NPI | 1538413653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SASHA IVERSEN Sole Member 281-912-3483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P4106) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2022-01-25 |