| NPI | 1639769649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EILEEN AHERN Credentialist 800-954-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Enumeration Date | 2021-01-23 |
| Last Update Date | 2021-01-23 |