| NPI | 1801774906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA VAN ETTEN Dir Of Credentialing & Accounts Pay 334-799-5853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |