| NPI | 1720383425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENNIE SISON Administrator 407-482-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center Rehabilitation (Licence: FL HCC 8963) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: FL CH5539) |
| 261QH0100X Clinic/Center Health Service (Licence: FL HCC8963) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2011-07-25 |