| NPI | 1629286794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN CALDECOTT DIETERICH Owner 361-548-5270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: IN 01043182A) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2020-08-22 |