| NPI | 1710322706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE ROBERTSON MADDUX Member 678-736-0724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 225XP0200X Occupational Therapist Pediatrics | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2025-07-23 |