| NPI | 1972626828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE TERPSTRA LARSEN Owner 219-796-7273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05001734A) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2008-06-20 |