| NPI | 1902572498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA GAYLORD Credentialing Manager 678-981-3543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-08-17 |