| NPI | 1912352022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA BROADWATER Executive Director 601-983-7494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 871546) | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2017-02-09 |