| NPI | 1619500212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER WILSON National Credentialing Manager 502-272-3463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2023-09-25 |