| NPI | 1003586207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65663) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225100000X Physical Therapist (Licence: PA PT033098) | |
| Enumeration Date | 2021-09-18 |
| Last Update Date | 2025-10-06 |