| NPI | 1609058445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DACOSTA ALONZO COLLYMORE CEO Owner 310-836-7650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 20709) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2008-06-24 |