| NPI | 1639938665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHEDA BROUGHTON Credentialing Manager 252-248-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2024-03-13 |