| NPI | 1003452459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63836) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MN 11751) | |
| 225100000X Physical Therapist (Licence: MS 6826) | |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2022-01-04 |