| NPI | 1831624881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN YOUNG Manager 435-609-6698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WY 0862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 1213) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-05-02 |