| NPI | 1871673996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAN CALDERONE BRIONES Owner 270-926-7320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 40170) |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty (Licence: KY 40170) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3007708) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2017-10-24 |