| NPI | 1053714071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21279) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2417) | |
| Enumeration Date | 2014-10-04 |
| Last Update Date | 2022-07-21 |