| NPI | 1871716001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE S WALLACE Office Manager 512-321-9659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 643460000) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-01-23 |