| NPI | 1023626116 |
|---|---|
| Former Name | KIA DANAE MATTISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10213) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2022-10-14 |