| NPI | 1851792352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MATTHEW HUEY Clinic Director 662-536-4096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MS PTA5483) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: TN PTA5777) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |