| NPI | 1053966267 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32110) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60970219) | 
| Enumeration Date | 2019-08-05 | 
| Last Update Date | 2022-03-29 |