| NPI | 1710749189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA CARLTON Owner 682-708-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-01-30 |