| NPI | 1790223477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH EVANS MCKENZIE Owner 318-715-7994 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0012749) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |