| NPI | 1962956367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA GAYLORD Credentialing Manager 678-837-7176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2026-01-07 |