| NPI | 1003400631 |
|---|---|
| Former Name | MARY DAVERN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 14176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28287) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2025-01-06 |