| NPI | 1568291839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STREETER Credentialing Specialist 904-944-4063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QR0400X Clinic/Center Rehabilitation |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-07-26 |