| NPI | 1962054858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY D GOLD Owner 210-724-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2023-06-13 |