| NPI | 1568232627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMILLE C REAGAN Provider/Owner 972-503-7272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207QS0010X Family Medicine Sports Medicine | |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |