| NPI | 1649826900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WALL Administrator 904-858-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2019-08-13 |