| NPI | 1063631273 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 019864) |
| 2251C2600X (Licence: NY 019864) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2026-03-09 |