| NPI | 1679522684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER M MOORE Owner 804-561-1617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305006053) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119002329) |
| 235Z00000X Speech-Language Pathologist, (Licence: VA 2202004731) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-01-09 |