| NPI | 1003168915 |
|---|---|
| Former Name | LEAH MICHELLE MARIETTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04276) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0011481) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2024-06-26 |