| NPI | 1659811354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN NICHOLS Owner 267-777-9872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: PA PT025855) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |