| NPI | 1053530527 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 788) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: AK 788) |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: AK CO004846) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-06-12 |