| NPI | 1992188403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE WAKEHAM Owner 915-209-0589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2019-11-25 |