| NPI | 1891844130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY EDWIN WALL Adminstrator 904-858-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL351) |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-01-24 |