| NPI | 1659516003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD JOSEPH WICKSTROM President 513-821-7420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: OH 3582) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: IN 05009555A) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: KY 001690) | |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2008-12-12 |