| NPI | 1801192307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD WILSON President 601-250-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2019-06-04 |