| NPI | 1811612799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WALL Administrator 904-858-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-04 |