| NPI | 1568835445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE MICHAEL KOPP Owner 251-633-5155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AL 30966) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2021-06-01 |