| NPI | 1861372633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED THOMAS BEVILLE VP Physician Network 318-716-4891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-22 |