| NPI | 1619480811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL SIMMERMAN Part Owner 910-297-9714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |