NPI | 1003475005 |
---|---|
Former Name | ALYSSA BREITBACH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 74041) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 76475-21) |
208100000X Physical Medicine & Rehabilitation (Licence: WI 8221851) | |
Enumeration Date | 2019-06-12 |
Last Update Date | 2023-08-25 |