| NPI | 1790780120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE FABRE FAIRLEY Member Manager 985-778-2282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 04964) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2022-09-01 |