| NPI | 1821698580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH BURLEY Owner 239-321-5759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2021-07-12 |