| NPI | 1962083006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARYTIE A OLIVER Credentialing Specialist 936-443-8460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-06-15 |