| NPI | 1053702514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 002302) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 1900-19) |
| 225200000X Physical Therapy Assistant (Licence: NY 007133) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 1362) | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2025-02-03 |