| NPI | 1568117612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCELLE A PETRY Owner 817-539-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111N00000X Chiropractor |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-02-17 |