| NPI | 1619647344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAJA IKOH Credentialing Specialist 704-900-8960 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2025-03-03 |