| NPI | 1619847456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN PENROD Director 888-248-2366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator |
| 207V00000X Obstetrics & Gynecology | |
| 208D00000X General Practice | |
| 208M00000X Hospitalist | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2025-11-07 |
| Last Update Date | 2025-11-07 |