| NPI | 1962803932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN BOUTIN President/Owner 662-231-7304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-10-20 |