| NPI | 1891304812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA NOWKA Owner, At, PT A 989-996-1098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-10-15 |