| NPI | 1548318025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE VON ANTZ Physical Therapist Administrator 228-255-3533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |