| NPI | 1962764142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL P GAMBACORTA Owner 843-236-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2024-09-05 |