| NPI | 1023397254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212365) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2021-12-17 |