| NPI | 1629828017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA STREETER Chief Administrative Officer 800-699-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2025-03-10 |