| NPI | 1780678417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MALLGRAVE Administrator 409-835-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 620030000) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2013-04-05 |