| NPI | 1649728064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANALYN ESCOBER DE LEON Owner 239-572-4779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 14774) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 24303) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2017-02-28 |