| NPI | 1568756757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE B CANNON Owner, President 866-484-8183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: PA PT003408L) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: PA PT003408L) | |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2019-03-04 |