| NPI | 1689051104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYLA BURRELL Credentialing Coordinator 888-590-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2021-10-20 |