| NPI | 1922630193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN ELISE CLARK Credentialing Manager 301-722-3215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2021-04-01 |