| NPI | 1578131728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANILO FAJARDO IGNACIO Authorized Official 315-887-0221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-07-21 |