| NPI | 1023572856 |
|---|---|
| Former Name | LAURA ASHLEY GLENN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61129926) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2013028602) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2021-01-11 |