| NPI | 1962094219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY JEAN MALLON Co Business Owner 541-490-4450 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2021-02-08 |