| NPI | 1639486558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN RILEY Physical Therapist 910-352-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: NC 10422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10422) |
| 261QP2000X Clinic/Center Physical Therapy (Licence: NC 10422) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2011-07-01 |