| NPI | 1679930796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISSETT TERRELONGE Owner 786-615-4346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: FL ME28516) |
| Additional Taxonomies | 208D00000X General Practice |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-09-29 |