| NPI | 1568203610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK HAM President 669-666-4936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083S0010X Preventive Medicine Sports Medicine |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 363LF0000X Nurse Practitioner Family | |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-07-13 |