| NPI | 1912110362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY WAGNER Administrator 352-336-1433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225700000X Massage Therapist |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2019-05-20 |