| NPI | 1851978340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI HARRELL Owner 662-832-8017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation Pediatric Rehabilitation Medicine |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2021-05-14 |