| NPI | 1942581277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN TROY BOUTIN President 662-840-0535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MS 1011705) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |