| NPI | 1548947872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE CLYDE ANDREWS Bht/Facilitator/Wellness Coach 480-925-1393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 171400000X |
| 175T00000X Peer Specialist | |
| 226000000X Recreational Therapist Assistant | |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2023-06-29 |