| NPI | 1063403392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 101389) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 100547) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2007-07-08 |