| NPI | 1053969063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTT44280) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL6146) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2026-01-12 |