| NPI | 1770884652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE STASZAK Owner 541-505-8180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2022-08-19 |