| NPI | 1902446792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE SIDECO Manager 702-326-0528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2021-04-20 |