| NPI | 1063799385 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017694) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26963) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2019-01-02 |