| NPI | 1982799516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN TROY BOUTIN President 662-231-7304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-09-27 |