| NPI | 1649664277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE MOORE Owner 317-691-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 070018656) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |