| NPI | 1740031343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAQUILLE HENRY Owner/CEO 347-606-6460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 261QR0400X Clinic/Center Rehabilitation | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-01 |