| NPI | 1891496725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA SELLNOW Admin 321-236-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| 207T00000X Neurological Surgery | |
| 207X00000X Orthopaedic Surgery | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2025-10-15 |