| NPI | 1861877748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HEGWOOD Credentialing Manager 307-463-0462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2021-01-11 |