| NPI | 1871664243 |
|---|---|
| Former Legal Business Name | BODY RENOVATION HEALTH SERVICES SC |
| Entity Type | Organization |
| Authorized Contact | RICHARD D WAGNER Partner 262-375-1075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2008-01-30 |