| NPI | 1619163763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNELL SHELTON Owner 347-247-8199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501009704) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201000319) |
| Enumeration Date | 2007-09-22 |
| Last Update Date | 2008-04-09 |