| NPI | 1902590201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SEAN SLOBASKY Owner 800-735-1178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant Surgical | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-08-22 |