| NPI | 1013481662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP060025T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30794) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2026-07-28 |