| NPI | 1063762474 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035055-1) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2016-05-23 |