| NPI | 1801350921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MILLER LANE Owner 913-745-4064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-09-27 |