| NPI | 1043331747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209236) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 1168) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2018-03-17 |