| NPI | 1902983794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISKA CHARLENE TRUESDALE Owner 910-619-4803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 4979) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-09-20 |