| NPI | 1003357625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016697) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38900) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002905) | |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2024-03-01 |