| NPI | 1770715336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD NICHOLSON Owner 712-299-0866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: IA 02144) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2020-03-04 |