| NPI | 1649663857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KACIE LINTHICUM Billing/Credentialing Specialist 409-883-5300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX J4239) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2026-02-20 |