| NPI | 1629554225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HUSSIEN BALLOUT Owner 321-387-9451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2025-10-09 |