| NPI | 1912512575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA ALEXANDRIA ABAZEED Credentialing Consultant 313-920-5522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-10-31 |