| NPI | 1912414996 |
|---|---|
| Doing Business As | PROVO REHABILITATION THERAPY |
| Entity Type | Organization |
| Authorized Contact | SOON BURNAM Delegated Official 949-540-1249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2024-06-28 |