| NPI | 1871244319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY W. BENNETT Owner 704-293-0202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-01-17 |