| NPI | 1639891880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY J BAUGHEY A VP, Credentialing & Enrollment 267-981-6519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-09-14 |