| NPI | 1992101638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRU NICHOLE BISHOP Credentialing Spec. 260-432-4700 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2014-11-07 |