| NPI | 1548404577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHEDA BROUGHTON Manager, Credentialing 252-248-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 002689) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2024-11-01 |