| NPI | 1770369423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZAUR GASANOV Administrator 469-250-1299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics |
| 235Z00000X Speech-Language Pathologist, | |
| 261Q00000X Clinic/Center | |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-09-07 |