| NPI | 1902839020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HATTIE WAGNER President 502-259-9101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: KY 101012) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KY 2470) |
| 225100000X Physical Therapist (Licence: KY 002058) | |
| 225100000X Physical Therapist (Licence: KY 004490) | |
| 225X00000X Occupational Therapist (Licence: KY R2591) | |
| 225X00000X Occupational Therapist (Licence: KY R2338) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2017-11-02 |