| NPI | 1023756376 |
|---|---|
| Former Name | JESSICA ANN LAVINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2025-09-12 |