| NPI | 1922355775 |
|---|---|
| Former Legal Business Name | CAPTIVE MEDICAL, PA |
| Entity Type | Organization |
| Authorized Contact | JASON CHRISTOPHER TINLEY Director 817-916-4685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2015-05-28 |