| NPI | 1548765670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY JO MCDONALD Billing Supervisor 228-863-1132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: M8456) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2018-03-29 |