| NPI | 1003121088 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30667)  | 
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL ma40447)  | 
| Enumeration Date | 2010-08-13 | 
| Last Update Date | 2015-09-08 |