| NPI | 1699301200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN TERRY STOCKTON Physical Therapist/Sole Member 505-206-1148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-03-14 |