| NPI | 1669711198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLA BURRELL Contracting & Credentialing Manager 888-590-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2017-02-17 |