| NPI | 1780109066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE EBSEN Financial Administrator 972-317-2612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2022-07-21 |