| NPI | 1689205635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES WILLIS Physician 469-965-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207LP2900X Anesthesiology Pain Medicine | |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2020-02-03 |