| NPI | 1588610513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FORREST L WAIDE Director 270-824-9227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2012-05-13 |