| NPI | 1063617306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7162) |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology (Licence: MN 7162) |
| 2251P0200X Physical Therapist Pediatrics (Licence: MN 7162) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: MN 7162) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2007-07-08 |