| NPI | 1942703426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILDEFONSO LAQUINDANUM Office Manager 901-848-6376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN PT5144) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2021-02-12 |