| NPI | 1558734566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANITA K RUSSELL Co Owner 870-612-0654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2024-10-10 |