| NPI | 1790289387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CARL DAVIDSON Organizer, Manager 318-623-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NC P12311) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NC 7348) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2018-04-24 |